An alopecia dictionary

Index

A

Acrylamide
This is an odorless chemical intermediate product in the synthesis of polyacrylamides. These high molecular weight polymers are used primarily as additive for water treatment where it removes suspended solids from industrial wastewater before discharge, reuse, or disposal. An epidemiological study by Roselino AM et al and published in the International Journal of Dermatology 35(3):181-4,1996 described seven cases of alopecia areata among workers in the Water and Effluent Treatment Sector (WETS) of a paper factory. The number represented a 0.6% Incidence, when the value for the population at large is 0.1%. Toxicologic evaluation revealed an acrylamide-like substance in the 7 workers with alopecia areata in contrast to 1 out of 11 controls. The authors suggested a statistically significant correlation eventhough the study did not correct for the large number of comparisons. Laboratory studies for other putative agents (e.g., bacteria, fungi, peticides, and heavy metals) were negative. More information about acrylamide may be found at the web site of the U.S. Environmental Protection Agency.
Addison's disease
A disease characterized by low blood pressure, and a brownish coloration of the skin due to decreased secretion of the hormone cortisol from the adrenal gland. Areas of hyperpigmentation may be generalized or limited to skin folds such as the creases of the hands and scars.
Adrenal glands
The adrenal glands sit atop the kidneys, and are responsible for producing cortisol (the human steroid) as well as a hormone which regulates water levels in the body (aldosterone).
Aloe vera
There are over 200 different varieties of aloe vera and product processing may change the extract natural properties. Aloe comes in gel, distilled liquid or "juice" (used for constipation and other colon problems), as an extract, and even reconstituted. It's very confusing.

The extracts of the aloe vera plant have a complex set of chemicals with the ability to suppress and stimulate the immune system in a number of ways. There are reports of clinical trials, of varying quality, suggesting that aloe vera has a positive effect on wound healing, immune stimulation, aalso aginast cancerc and in the treatment of various viral conditions. There is also a recent report of its effectiveness in the treatment of psoriasis.

Alopecia
Hair loss (alopecia) can be separated into different classes according to whether it is scarring or nonscarring, diffuse or patchy. In scarring alopecia, the hair follicles are involved by inflammation. The attendant fibrosis and loss of hair follicles prevents any potential regrowth. Scarring is manifested by a pale, glazy and smooth scalp. Examples of scarring alopecia include discoid lupus erythematosus, acne keloidales nuchae, morphea, burns/radiation, and chronic infections. Most patients in clinical practice are classified as having a nonscarring alopecia. This type includes alopecia areata, androgenetic alopecia, telogen effluvium, traction alopecia, trichotillomania, secondary syphilis, endocrine, drug/chemo, and nutrition. The alternative classification of diffuse hair loss includes androgenetic alopecia, telogen efluvium, endocrine, nutirtional, frug, and rare cases of alopecia areata. Types of patchy hair loss include alopecia areata, fungal infection (tinea capitis), discoid lupus, traction, and acne keloidalis nuchae.
Ames test
The Ames test has been around for some time. Its purpose is to test chemicals as potential carcinogens by their ability to mutate bacteria. The government uses it because it is quick, simple and relatively cheap. If a chemical proves positive with an Ames test, animal studies are then performed. The test itself is "in vitro" and uses a lower species, making any results difficult to extrapolate to humans. Among the topical immunotherapeutic recommended for patients with alopecia areata, DNCB has proven carcinogenic. This is no longer a therapeutic option to consider.
Anagen
The active growing phase of the life cycle of the hair. It lasts approximately for 3 years with a range of 2-6 years.
Anthralin
A chemical irritant with an extensive history of use in psoriasis. It produces irritation and discoloration of the skin and is often used in combination with tars and ultraviolet radiation (see section 6 for chemical irritants). In psoriasis it helps control the rapid growth of skin cells. Some people believe that in alopecia it works by competitive inhibition, i.e., it causes so much inflammation that the "bad" white cells present can't do their damage.

Anthralin is available as a greasy ointment (Anthraderm) and also as a non-greasy vanishing cream (Dritbo, Lasan). Whether drithocreme or micanol (types of anthralin) are more effective, if at all, is unclear to me. Studies show anthralin works from 0-82% of the time! It is applied to the bare patches once daily and washed off after a short time, usually 30-60 minutes later. If new hair growth occurs, it is seen in eight to twelve weeks.

Antibiotics
Treatment of alopecia areata with antibiotics goes way back to the time when its origin was thought to be infectious. Another theory was that dental infections caused the disease. Shelley and Shelley, MD's in Ohio began popularizing antibiotic treatment of alopecia areata in the past decade. Lutz, MD found AA patients had high levels of ASO and antiDNAse antibodies, suggesting a streptococcal origin or prompt. It is unclear how effective treatment with antibiotics is in alopecia areata.
Antimicrosomal antibodies
There is a blood test for "antithyroid microsomal antibody." It also goes by other similar names: antimicrosomal antibody; microsomal antibody, thyroid autoantibody, thyroid antimicrosomal antibody. Microsome is defined as "any of the vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells." Whatever it's called, the test is to detect thyroid "microsomal" antibodies. Approx. 70-90% of people with Hashimoto's thyroiditis have the antibodies; but another 5-10% of "healthy" people also have them -- their titer (count) is low.

According to Mosby's diagnostic and laboratory test reference, "Microsomal antibodies are produced in response to microsomes escaping from the epithelial cells surrounding the thyroid follicle. These escaped microsomes then act as antigens and give rise to antibodies. These immune complexes initiate inflammatory and cytotoxic effects on the thyroid follicle. This test is usually performed in conjunction with the antithyroglobulin antibody test."

Antinuclear antibodies (ANA)
As the name suggests ANA's are immunoglobulins (antibodies) directed against different constituents of the nucleus of a cell. Under the microscope, cells reacting with these antibodies exhibit different staining patterns. In some, staining of the nucleus occurs in a uniform fashion, in others only the margins of the nucleus are apparently involved, there is also a speckled pattern, etc.. When the clinician interprets the laboratory tests, he takes into consideration both the pattern and the amount (titer) of these antibodies. Very high numbers of these antibodies staining the nuclei of cells in a speckled fashion have been associated with systemic lupus erythematosus. High titers staining the nuclei of cells in a dot-like configuration (nucleoli) are suggestive of scleroderma and polymyositis. Because of the variabile expression, the test results should be done primarily by a specialist. Occasionally positive ANA's have been reported in completely normal individuals (a false positive), in aged individuals, patients with a positive family history of autoimmune disease, and in patients suffering from other chronic conditions (e.g.., several rheumatic, autoimmune, and inflammatory arthritides). Some of these conditions include Sjogren's syndrome, chronic active hepatitis, autoimmune thyroiditis, lymphoproliferative disorders, chronic bronchitis, tuberculosis, pernicious anemia, ulcerative colitis, myasthenia gravis, and infectious mononucleosis. Positive readings can also occur as a result of numerous drugs, including "simple" ones like penicillin, tetracyclines, streptomycin. At the other end of the spectrum, *false* negative readings can occur as a result of using steroids.

The problem with having a disease characterized by antibodies against nuclei is that ALL cells of the body have this structure. The disease may therefore affect the brain as well as the kidney, or the joints. In other autoimmune conditions the antibodies are directed against a portion of a specialized cell and may therefore be restricted to a specific tissue type (e.g., skin).

Antithryglobulin antibodies
Antithyroglobulin antibody - has other names, like thyroid autoantibody, etc.) can also show up in Hashimoto's thyroiditis (about 50% of patients). But, abnormally high levels can also indicate hypothyroidism, rheumatoid arthritis, pernicious anemia, etc. (See also antimicrosomal antibodies). Hairloss is a common symptom of thyroid disorders. Antithyroglobulin antibodies is part of the laboratory testing used to establish the diagnosis of thyroid disorder.
Apoptosis
From the Greek words "apo" meaning off and "ptosis" to fall. Apoptosis or falling off is a type of cell suicide or programmed death. This type of cell death occurs by fragmentation of membranes that are then eliminated by phagocytosis. Several articles claim that apoptosis is a possible mechanism mediating cell death in both androgenetic type alopecia and alopecia areata.
Aromatherapy

“I'm still using the aromatherapy oil on my head. Smells better than olive oil. I really don't know how much difference either actually makes, but I do have an itching problem in my scalp as well, and the aromatherapy soothes the itching somewhat.”

An article about aromatherapy and alopecia appeared in Natural Health September/October 1997 issue. In the article, a women who suffered from AA since children and was losing all of her hair, recounted her use of aromatherapy and cayenne extract. Each night before bed, she massaged a mixture of lemon, lavender, rosemary and carrot seed essential oils in a base of jojoba oil into her scalp (no information as to the total amount of each mixed was provided). In the morning, she stimulated her scalp with cayenne pepper extract and a soft toothbrush followed by rinses of hot and cold water. She claims to have seen regrowth in about three months and had a full head of hair after six months. She has not had a recurrence of alopecia since beginning her therapy.

In "The Complete Book of Essential Oils and Aromatherapy" by Valerie Ann Worwood several recepies are recommended using oils:

Alopecia Shampoo

Blend ingredients together in a bainmarie and use the shampoo once a week.

  • Soap stew 4 ounces
  • Jojoba Oil 12 drops
  • Carrot Oil 6 drops
  • Rosemary 6 drops
  • Lavender 10 drops

Alopecia Conditioner

Blend the ingrediants together and massage into scalp. Leave on the hair at least 30 min. before washing off.

  • Jojoba oil 1/2 teaspoon
  • Evening primrose 10 drops
  • Palma Rosa 3 drops

At night time

Every night apply the following treatments all over the scalp. Mix together and store in bottle. Use 1 teaspoon for each application diluted in 1 tablespoon of cold cold water. This one doesn't smell to great and your husbands/boyfriends may not want to sleep next to at night

  • Cider vinegar 4 ounces
  • carrot oil 20 drops
  • Rosemary 10 drops

In the book it states, "Essential oils, and indeed many nut oils can stimulate the hair follicle and increase circulation and oxidization sufficiently to bring regrowth of hair, although in some cases this may resemble vellus or baby hair".

Some of our members have used the following recipe with some success:

  • 1 tbls. Jojoba oil
  • 1 tbls. Calendula infusion oil
  • 1/2 tsp. Carrot seed oil
  • 10 drops Lavender essential oil
  • 6 drops Clary sage essential oil
  • 4 drops Cedarwood essential oil
  • 4 drops Rosemary essential oil

In a small amber glass bottle, add the jojoga oil and carrot seed oil. Add the essential oils and shake to mix. Label. Warm the oil before application by placing it in a warm water bath. Apply by massaging a few drops into the scalp area. Leave in to be absorbed. Apply several times weekly.

Note: Small amounts of essential oils are used with the same amount of carrier oils for children. Example: where ever you read essential oils you must cut drop amount in half. Rosemary would then be 2 drops. Carrot seed oil is hard to find, expensive but a very good oil for hair problems. Calendula oil must be made by infusion (made from actual herb sitting in olive oil in the sun for about three weeks, shake from time to time.

Of related interest is an extract from the book "Herbs: Their Cultivation and Usage":

Lavender
It is claimed that rubbing oil of lavender on burns does not relieve the pain, but assists in healing scar tissue. Calms the nerves and relaxes tensions. Has a good effect on digestion. Lavender and valerian have both been recommended for people having trouble sleeping.
Rosemary
Rosemary's main attribute is its association with all functions of the head. Extract of rosemary in shampoos and hair tonics revitalizes the scalp, prevents dandruff and encourages new and healthy hair growth with a shining lustre.

For people with sensitive skin some great non-irritating soap recipes can be found in Sandy Maine's "The Soap Book". One of the recipes is made of lavender and rosemary essential oils and comfrey root powder.

The scientific community has joined the aromatherapy bandwagon. A recent article by Hay, Isabelle, et. al. "Randomized trial of aromatherapy: successful treatment for alopecia areata." Archives of Dermatology. Vol. 134. November 1998. 1349-1352 focuses attention on this possible therapeutic intervention. The researchers in the study used a mixture of cedarwood, thyme, lavender, rosemary, jojoba, and grapeseed oils. The mixture was massaged in the scalp of patients every evening for two minutes. A placebo control group received only jojoba and a grapeseed oil mixture. To be honest, when you have a good look at the study, there are holes in it, and the title of the article is a little over optimistic. It does not mention how long people had areata, how they randomized the groups, and whether or not they had other associated disorders. Sometimes aassociated conditions (such as thyroid disorders) are a factor in a positive or negative outcome.

For those people who have tried aromatherapy, it smells too much and doesn't work all that well. What they would like is aromatherapy without the aroma!!! Additional information about this therapy can be found in a newsletter called The Integrative Medicine Consult (February 1, 1999 Volume 1, Number 4). If you would like to try it the following are some suggested dosages:

  • Active oils: 2 drops (88mg), Thyme (Thyme vulgaris); 3 drops (108mg), Lavendar (Lavendula agusifola); 3 drops (114mg), Rosemary (Rosmarinus officinalis); 2 drops (114mg), Cedarwood (Cedrus atlantica)
  • Inactive carrier oils: 3mL jojba oil; 20mL grapeseed oil. Grapeseed oil is very slippery and not well absorbed into the scalp. It may have been used as a carrier because it is very cheap.
  • Massage into scalp each evening for a minimum of 2 minutes; follow with warm towel wrap to aid absorption of oils. Aromatherapists recommend giving 1/3 to 1/2 of the dose for children under 12.

Avoid using red thyme, one of the various types of thyme. This is a potent counter irritant and will burn the scalp. This kind of thyme used with one of the better (more expensive) and more irritating forms of rosemary causes scarring. Of the scarring types of thyme- one drop can be used per 20 ml of carrier oil. Several of the inexpensive forms of rosemary are recreational but do not have the therapeutic benefits found in some of the other more potent forms. These forms may not be specified on the bottles of oil.

You may try rubbing the solution into the scalp for two minutes each day and then a warm towel or other covering is applied on top for 10-20 minutes. The scalp is not washed for at least four hours after.

Two sources for aromatherapy oils

Belle Star Inc
23151 Alcalde
Laguna Hills, CA 92653

But an even better source is:

Yerba Buena
1809 Fourth Street
Berkeley, CA  94710

The above is a "purveyor of herbs, spices, teas, essential oils and aromatherapy accessories". They do mail order, but they don't have a catalog of their goods. Phone # is 510 548-3500.

Note: People with high blood pressure, epilepsy and who are pregnant should not use aromatherapy.

--See also section 6 under Other Problems: Changes in Skin Pigmentation.

Arthritis
Inflammation of the joint. Osteoarthritis is bony bits in the joint which causes pain and swelling. Rheumatoid arthritis is caused by the immune system attacking the joint.
Atopic dermatitis
An allergic response in the skin that causes itching and subsequent excoriation (see also eczema).
Atrophy (skin)
Thinning of the skin due to diminution in any of its components. With epidermal atrophy the skin looks thin, translucent, and wrinkled like a cigarette paper. Atrophy of the much thicker dermal layer results in a depression. In both cases (epidermal and dermal atrophy) the blood vessels are easily seen through the skin. There are two times a person with alopecia areata may aquire skin atrophy. One is as a side effect of steroids, case in point, "My Dermatologist also suggested that he could inject my eyebrows because people have great success in growing them back that way. I thought, what the heck, it would be great to have eyebrows again. Well, he did it, and instead of brows I got big, deep, wrinkles in my forehead (I looked about 90!). He assured me it would only be temporary (it lasted months)." The other occasion is when you loose your hair. The hair follicle and its appendages undergo an involution the end result of which is a diminution in the width of the scalp, case in point, "I have noticed that my scalp is depressed in the area of the baldness. It has become noticeable to me because the area that is growing back seems to have built up again."
Autoantibody
An antibody directed against normal tissue. Occasionally autoantibodies may be recognized in serum. In some cases the titers of autoantibodies may correlate with disease severity and provide a useful way of monitoring long-term prognosis. In other cases the presence of an autoantibody does not establish a cause effect relationship to the disease. Some other process may have released or altered a given antigen so that autoantibodies are produced secondarily. The presence of autoantibodies by themselves does not necessarily mean that the patient has a disease.
Autoimmune disorder
A disease resulting from a disordered immune reaction in which antibodies attack one's own tissues as in lupus and rheumatoid arthritis.
Autoimmune polyglandular syndrome
Over the past 50 years or so a number of disorders of unknown causation have been classified as autoimmune based on the clustering of various laboratory abnormalities. The diagnostic scheme for autoimmune disorders is based among other things on:
  1. The presence of inflammatory cells (lymphocytes) clustering against a particular component of an organ. Similar to alopecia areata these inflammatory cells consist primarily of CD4 and CD8 lymphocytes.
  2. The presence of organ specific autoantibodies (see dictionary).
  3. The association to HLA genes (see dictionary).

The association of multiple endocrine disorders in the same patient prompted Blizzard, Maclaren and Neufeld to use of the term Autoimmune Polyglandular Syndromes (APS) for these conditions. Their Type I APS may be seen in young adulthood or early childhood and has an equal incidence in both males and females. It is comprised primarily of three primary disorders- Addison's disease, hypoparathyroidism and chronic mucocutaneous candidiasis. The prevalence of these associated disorders has been summarized as follows:

Endocrine disorders
hypoparathyroidism90%
Addison's disease60%
Gonadal failure45%
Autoimmune thyroid disease10%
IDDM (insulin dependent diabetes mellitus)1%
Nonendocrine disorders
mucocutaneous candidiasis75%
malabsorption syndromes25%
ALOPECIA20%
pernicious anemia15%
chronic active hepatitis10%
Sjorgen's syndrome5%

Type II APS is the more common type of polyglandular failure. It is seen at all ages but more commonly in adults. There is a strong female predominance and often there are family members with similar manifestations. The most common endocrine abnormalities in this group include Addison's disease, autoimmune thyroid disease, and IDDM. Common nonendocrine type of manifestations include ALOPECIA, vitiligo and premature greying of the hair. (For more information see WJ Riley Horm Res 38(suppl 2):9-15, 1992.)

The following is a letter writen to me by a patient suffering from this condition:

Hi! I am contacting you after having read your letter about your daughter's hairloss and how it has inspired your research. I am very moved, to say the least. I am a 37 year old woman, living in Los Angeles where I was born. I was exposed to DES (Diethylstilbestrol) in utero and now suffer from multiple autoimmune endocrinopathies. (at least 7 different types). I have had brief periods where I have experienced excessive hair loss, though always with regrowth immediately afterwards... this year I have lost more hair than ever before and i am developing bald spots where no new hair seems to be sprouting. It is a very traumatic thing to have to go through, although I am less concerned about my appearance than I am about my health. I have not been seen by a Doctor (regarding my autoimmunities) since I was "turned loose" from UCLA's medical research center 17 years ago... I was molested by a Doctor during my first year there as a patient/oddity along with having been a "guinea pig" or a living cadaver to be poked and probed with no consideration for the frightened teenager lying naked on the table. Two years ago I took a fall on some steps and broke my wrist. The osteopath who treated me discovered that my bones (after 2 months in the cast) did not seem to be fusing, or were healing at an extremely slow rate. It was then that I discovered that I was in the advanced stages of osteoporosis. I have beeen unable to get any kind of health insurance...am presently on state disability (as I am manic depressive and suffer from severe attacks of panic and anxiety) and when I look ahead to what the future may bring, I see nothing....and it is such a strange thing to live without any hope whatsoever. I am not so much afraid as I am lost. The Doctors at UCLA had placed me on estradiol and provera, which, as I told them, caused me to feel as though a war was taking place within my body. I was experiencing more extreme highs and lows than I'd ever known (which is truly saying something!!) and yet, was told consistantly by one Doctor after another that the replacement hormones "should be making me feel better"...as though I was not cooperating.!! Finally, I just gave up. I took it upon myself to stop taking the hormones as well as the advice and mental abuse I had come to expect from all Doctors. I am not sure what I'm asking for here... I don't know what I want or even that I COULD want for something...I just maybe want to be heard without being told that I am wrong or that it is my fault that I don't respond well to the medicines I've been given. I do have one hope and that is, that by hearing this, perhaps it will contribute somehow, a bit more information, to your research. So...I guess I DO have some hope alive within me, after all...Please feel free to share any of this letter with your daughter, if you feel it would be of any benefit to her. If nothing else, she might understand that she is not alone... If she needs or wants to communicate with me, I would welcome it!

B

Bath oils
A lubricant and anti pruritic product added to your bath in order to relieve dryness. These oils make the bathtub quite slippery, so be careful.
Beta catenin
A few years ago it was noticed that a protein, beta catenin, was associated with cells which were destined to become hair follicle cells in embryonic mice. More recently the group (Elaine Fuchs at U. Chicago) made transgenic mice which expressed a form of the protein which hangs around cells for longer than usual. These mice showed extreme hair growth, sometimes to the extent that benign follicle tumours developed due to excessive stimulation of the cells. Unlike 'natural' growth, the hair grew in all directions. They now are asking whether a topical application of this could be developed, whereby baldness could be treated by creating new follicles. George Cotsarelis is quoted as saying that the work is 'outstanding' but doubts whether any treatment of baldness is feasible this way. However, for us pecians, if current ideas are correct, then new hair follicles are presumably going to be zapped by the immune system just as readily as the old ones.
Biotin
One of the essential water soluble vitamins manufactured in the gut by bacteria. Another chemical called avidin (found in raw egg white) binds to biotin and prevents its absorption. Symptoms of biotin deficiency include lack of appetite, nausea, vomiting, and depression. In experimental animals biotin deficiency has caused an eczematous dermatitis and loss of hair around the eyes (the so-called "spectacle" eyes). Some people recommend taking biotin for nail problems (See Nail Changes in section 6). Remember that biotin is water soluble. What this means is that if you take more than your body needs it will be excreted by the kidneys, through the urine. The reccomended daily allowance of biotin is 300mg.
Bleach
A chemical used for the alteration of hair color. It usually contains hydrogen peroxide/ammonia mixtures.
Bonding
This is a type of non-surgical hair replacement that uses a horseshoe-like track of existing hair about 1/4 inch wide is shaved to about 1/8 of an inch long. The hair is shaved close to the head approximately 1/32" in length. The bonding glue is then applied to the hairpiece which is attached to the hair, NEVER ON THE SCALP! The bonding method is to be used on people who have hair to bond to. You do not want to bond directly to the scalp. Bonding lasts approximately 6 weeks, as the hair grows the hairpiece slips around and must be tightened. Removal is with solvent (sometimes baby oil and alcohol) or it can be cut off.

Male pattern baldness is where the bonding method works best. Those of us with AU and AT should never bond hair as we do not have the hair to which the bonding glue can be applied. I do not suggest that it be used for AA for two reasons. First, the fall out pattern of AA is unpredictalbe and the bonded hair may be gone tomorrow. Second, the existing hair is in such a fragile state and putting excess stress can excelerate the loss.

In some cases the bonding method of hair replacement can be used for women with androgenetic hairloss. My only caution with this method is the excess stress it places on the existing hair. It is important with thinning hair that the attachment (bonding, clips, tape) be rotated to give the existing hair a rest. Continued use of attachments will cause traction hairloss.

Boric acid
Boric acid and sodium borate are potentially toxic to people and pets. Exposure to boric acid (e.g., after a mouthwash) has caused diffuse alopecia. If taken with suicidal intent, it may cause total alopecia after ten days. Serious poisonings in humans have rarely been reported following a single acute ingestion. Toxicity is more likely with repeated exposure to raw or abraded skin or from repeated ingestions.
Braiding
Braiding is another attachment method used sometimes used for AA. This is when the existing hair is braided in long rows and hair extensions are sewn to the rows. This method pulls on the already fragile hair and causes it to come out even faster.
Broader spectrum of alopecia areata symptomatology
A compendium of most studies on the genetics of alopecia areata will indicate on average that approximately 20% of patients have an affected relative with the same diagnosis. Furthermore, these studies indicate that the severity of the condition in the proband in no way predicts the amount of involvement in any other affected member. Although there are several groups around the world collecting families with AA/AT/AU for use in genome screen, it is my personal belief that their experimental designs are flawed and will lack power to show genetic linkage. Additional power could be added to the studies if phenotypic manifestations (phenotype= symptoms expressed in a genetic condition) of the genetic liability to alopecia areata could be documented. Let me explain- There are many studies and patient testimonials indicating that patients with alopecia areata do suffer a selective vulnerability to allergic disorders, e.g., hay fever, asthma, eczema. Although these allergic disorders are very commonly seen in the general population (approximately 15%), their incidence in patients with alopecia areata is more than double (approximately 40%). I would argue, or theorize, that these atopic disorders are similarly expressed in the parents, siblings and relatives of patients with alopecia areata. These characteristics although milder and falling short of expressing hair loss, comprise what I would call the "broader spectrum of alopecia areata symptomatology" (BSAAS). In essence I would postulate that hair loss in patients with alopecia areata represents the tail of the distribution of a whole host of symptoms. My point is that studies limiting the phenotype of classical allopecia areata to hair loss may not be the most accurate way of finding the gene(s) for alopecia areata.

There is an interesting article by Matthysse et al. (J Psychiat Res 26(4):461-473) written from the mental health perspective that recommends various "bootstrapping" techniques to "turn non-Mendelian into Mendelian phenotypes." One of the techniques (detailed in Matthyse and Parnas J Psychiat Res 26(4):329-44) is to expand the phenotype in order to increase the number of persons with the condition. The assumption is that a "minor" gene for the disorder may be a "major" gene for something else, eg, a minor gene for eczema may be major gene for alopecia areata.- I do believe that the most parsimonius model for alopecia areata is one where several genes interact with one another to produce the BSAAS.

One way to offer suggestive evidence for this was of thinking is to make a survey among our participants and divide them into 2 groups. One group would have only one person affected and the other group would have at least two persons (brothers/sisters/brother-sister/children) affected. Finding a higher prevalence of atopic disorders in the parents of those families having two siblings affected would suggest that the broader phenotype is a manifestation of the same genetic liability.

Bronchial asthma (asthma)
A disorder of the lungs characterized by wheezing, difficulty in expiration, coughing and a feeling of constriction in the chest.

C

Cadaverized hairs (Cheveux cadaverisees)
Small plugs of degenerated hairs in the follicle opening. Their presence suggest a rapidly spreading foci of alopecia areata.
Callousness
A physician who advises the parents of a young boy with Down syndrome that their son will never be aware of his appearance or hair loss because he is mongoloid.
Candida
Candidia albicans is a yeast like fungus that inhabits the body and can get into the blood stream, and sometimes gets out of balance and takes over. Candidiasis can effect various parts of the body most common being the ears, nose, gastrointestinal tract, and bowels. Other areas or symtpoms known to occur with Cnadida overgrowth are muscle and joint pain,sore throat, congestion nagging cough, numb hands, legs, or face, tingling sensation, vaginitis, kidney and bladder infections, arthritis, depression, hyperactivity, hypothyroidism, oral thrush, athlete's foot, ringworm, and jock itch.

Changing our diet can lower the levels of Candidiasis, by avoiding some foods and adding some supplements like essential fatty acids (flaxseed oil ect) and garlic oil suppresses the Candidiasis growth.

Catagen
The end of the active growing phase of the life cycle of the hair. It is a transitional stage between the growing phase (anagen) and the resting stage (telogen). In catagen all growth ceases and the "club" hairs are formed.
CD4/CD8 ratio
The regulation of the cellular branch of the immune system called "T-cells" are usually expressed in terms of help and suppression. CD4 (helper) cells refer to a special type of T-cell lymphocyte that recognizes foreign substances, helps mount an antibody reaction against the same and helps recruit other cells to ward of the invader. CD8 cells, on the other hand, try to suppress the immune response.

The CD4/CD8 ratio is widely used in clinical practice although the values themselves have to be standardized for each laboratory. A low number may signify that your CD4 lymphocytes are low (as in AIDS) or contrariwise that the CD8 cells are in overabundance (e.g., an infection with EBV, hepatitis B virus, or even cytomegalovirus). There are at least a dozen or so publications on the subject of CD4/CD8 ratio in alopecia areata. The results have been somewhat variable. One possible explanation is that some studies compared apples and oranges including in their analysis active patients along with those in remission. Our own study showed that in patients with active alopecia areata (proven by biopsy) this ratio is increased. Other studies have led me to believe that it is due to the combination of both an absolute increase in the number of CD4 cells and a diminution in the CD8 cells.

Celiac disease
It's an intestinal disorder caused by a wheat/gluten allergy. Celiac disease has a prevalence of 1:200 in Europe. Gluten itself is the proteins (primarily gliadins and glutenins) left behind after starch is washed away from wheat flour dough. Symptoms are diarrhea, bloating and general stomach discomfort after eating wheat -- can be severe or mild. Atypical symptoms include anemia, short stature, growth retardation, and alopecia. There is also a "silent" form of celiac disease wherre the patient is positive for antibodies (see below) but has a normal intestinal biopsy. This group develops celiac disease later in life. The disease manifests itself when the intestine's villi lay down flat and stop absorbing nutrients. Many problems follow due to malnutrition.

In the April 3, 1996 Journal of the American Medical Assn a study appeared that associates alopecia areata and celiac disease (see also: Celiac disease and alopecia areata: Report of a new association", Corazza G, et al. _Gastroenterology_, 1995, vol. 109, 1333-1337). The treatment for celiac is a wheat-free, gluten-free diet. This was tried on a fourteen year old boy with aa, and it resulted in full regrowth of head and body hair. The study showed that three patients who were asymptomatic for intestinal disease but had aa tested positive for celiac disease. The study suggests that aa may be the only clinical manifestation of the disease and recommends that antigliadin and antiendomysial antibodies should be included in the work-up of patients with AA.

Apparently many people are allergic to glutenous products. This is probably due to the fact that we tend to overuse gluten in our American diet. Gluten includes wheat, oats, barley and rye. Gluten is the component in these products that makes them sticky, allowing them to be kneaded into breads. Alternatives to these grains include amaranth, quinoa, millet, buckwheat, rice and corn. Also, teff, spelt and kamut have low levels of gluten and may be tolerated by some. Although wheat and gluten are tough to avoid in processed foods and in restaurants, it's not that difficult to avoid with fresh foods you make yourself.

Avoid:

  • Malt (in any form) syrup, flavoring etc.
  • Malto-Dextrins -- this food additive is either made from barley malt or acorn flour. It should be avoided if the source is unknown.
  • Colorings and Dyes from lakes expecially red and yellow
  • Hydrolyzed Vegetable Protein (HVP) Hydrolyzed Plant Protein (HPP) and Textured Vegetable Protein (TVP)
  • Monosodium Glutamate
  • Emulsifiers
  • Lectins/Lecithins (some celiacs react to these)
  • Canola Oil (some celiacs react to this)
  • modified food starch -- can be made from wheat or acceptable ingredients such as corn arrowroot potato tapioca or maize. This is one of those if you don't know don't eat it kinds of foods.
  • gluten peptides
  • hordeins of Oats and Barley
  • Distilled white vinegar (if distilled in grain) and malt vinegar
  • ethanols/extracts proteins from grains can be carried over into alcohols and extracts such as vanilla during processing.
  • Wheat, barley rye, oats, spelt, semolina, kamut, triticale, quinoa, millet, buckwheat, amaranth, tef
  • Fat replacers including Olestra, Otrim,Replace
  • Natural Flavor --can contain gluten-containing grains

Lots of good stuff you can still eat: vegies, fruit, dairy products, rice cakes. Of course, the more other things you don't eat (like dairy products, meat, sugar, etc), the harder it is. You can eat dairy products, but not red meat. Not eating pasta is the hardest -- but there is pasta made from vegies (like Jerusalem artichoke hearts) in health food stores. It is certainly true that you have to read the labels because "soy protein" which can contain wheat seems to be in everything, also caramel and malt flavoring. Some ice cream even contains the stuff. Because so many people are allergic to gluten, there are a wide variety of products available ("wheat-free" or "gluten-free") that can be found at health food stores. A catalog containing wheat-free and gluten-free bread mixes and related things is produced by Wilde Temptings (1-800-434-4846). Bette Hagman has great "gluten free gourmet" cookbooks which have recipes for gluten free deserts and breads you can make in a bread machine. Remember that there are flour replacements such as rice flour, potato starch flour, tapiocca flour and more. You don't have to do without good food.If you would like to know more about celiac disease a good web site to visit is www.celiac.com.

Cell culture
To grow cells on a medium for scientific study, medicinal use, etc.
CGRP
Theodore J. Daly of Garden City Dermatology, New York has recently had an article published in the Archives of Dermatology. This article has been publicized by several news networks (July 1998).

Dr Daly's research has focused on examining the blood plasma levels of the vasodilator/immunomodulator CGRP (Calcitonin Gene-Related Peptide) in people with alopecia areata. He took serum samples from 18 people with alopecia areata and 69 control samples from people without alopecia areata. The serum samples were analysed using a technique called "radial immunodiffusion" (RIA). This is a simple technique to define concentrations of biological substances in solution. Dr Daly found that in people with alopecia areata the concentration of CGRP in the plasma was about half (53%) that of control samples.

Dr Daly suggests that this apparent lack of CGRP could have an important influence on alopecia areata development. He believes that without the vasodilatory properties of CGRP there may be a reduced blood flow to hair follicles and this may result in dystrophic hair follicles less able, or unable, to produce hair fiber. In his own words (from a post to our list server): "AA may be autoimmune in nature, but I believe that CGRP, a potent vasodilator and immunomodulator, is first decreased in patients with AA. We have shown lower serum levels and other researchers have shown lower tissue levels. The low CGRP causes the hair to grow poorly due to decreased blood supply and allows the immune aspects of the hair to be exposed due to lowered immune protection by CGRP. I call this the 2 steptheory-1)low CGRP 2) immune response. I believe both aspects must be corrected to have hair regrowth." He also suggests that lack of blood flow may also account for nail pitting, eczema, and pigmentary abnormalities.

CGRP also has immunomodulatory properties and apparently suppresses antigen presentation to lymphocytes and slows down their proliferation and reactivity. This suggests that people with a deficiency of CGRP may have a greater susceptibility to inflammatory reactions as occur in alopecia areata. Calcium, nicotine, caffeine as well as steroids and pregnancy increase CGRP levels

Dr Daly believes that this deficiency in CGRP shows that people develop alopecia areata as a result of deficient thyroid production and that the autoimmune hypothesis of alopecia areata development needs to be modified or may be entirely wrong. He believes that using treatments directed at replacing and/or increasing levels of CGRP in the blood stream of people with AA may be an effective promotor of hair regrowth.

Some comments would be:

  1. Eighteen samples is a very small number to draw sweeping conclusions from. We had a previous "break through" a few years ago with the announcement by one research group that they had found cytomegalovirus in alopecia areata affected hair follicles in a small study. This study was repeated by other scientists (using many more alopecia areata affected volunteers) who were unable to obtain similar results.
  2. Which comes first, the alopecia areata or the reduced CGRP levels? CGRP concentration may change as a result of the systemic activity of inflammatory hair loss. So the lack of CGRP may simply be a consequence of alopecia areata and not a cause.
  3. Lack of CGRP does not suggest why just hair follicles should be attacked. CGRP is universally available (or not as the case may be) throughout the body. Why aren't other organs attacked in people with alopecia areata if CGRP is a trigger for inflammatory reactions?
  4. Over 50 years ago vasoconstriction/blood flow in alopecia areata affected hair follicles was shown not to be significantly different from that seen in normal hair follicles. There is no reliable evidence that vasoconstriction is what causes hair loss. If it was then that would suggest that vasodilators such as minoxidil would be much more successful than they apparently are in treating AA. There are many vasodilatory drugs that have no apparent effect on hair growth in androgenetic alopecia or alopecia areata.
  5. His treatment which may have potential even if CGRP is not fundamentally involved in alopecia areata development. If CGRP does have immunosuppressive effects then it may be useful regardless of the native CGRP concentrations in people with alopecia areata.

References for CGRP in AA include:

Rossi I et al. Neuroreport. 8(5):1135-8, 1997

Daly T. Archives of Dermatology 134,1164-5,Sept 1998

Mijalovic B. V Pregled 54(1):31-3. 1997

Daly T. Journal of Investigative Dermatology June 1999

Atkin D JAAD 37(5).Pt 1, 796-7, 1997

Chemotherapy
Literally - any therapy done with chemicals. It had come to be thought of as drug therapy for cancer only, although taking penicillin for that lung infection is also chemotherapy.
Chinese medicine (accupuncture)
There have been several recorded medical treatments for alopecia in the traditional Chinese medical literature where the condition is known as YOU FENG (greasy wind). It was claimed to be caused by blood deficiency, wind, and dryness due to insufficient kidney Yin. The Orthodox Manual of Wai Ke states, "You Feng is due to blood deficiency which results in failure to nourish the skin by the ascending Qi". Systemic herbal treatment is directed at replenishing the blood, dispeling the wind and strengthening the kidney. Some accupuncturist claim that hair is a by-product of blood. Suposedly, when you are stressed or pregnant less blood goes to your scalp thus preventing the growth of hair. Many of these claims remain unproven by modern scientific studies.

The herbs used in the systemic treatment are usually complemented by drinking lots of water. Systemic treatment consists of mixing equal portions of Rhizoma seu Radix Noptergii, Fructus Chaenomelis lagenariae, Rhizoma Gastrodiae, Radix Paeoniae albae, Radix Angelicae sinensis, Semen Cuscutae, Radix Rehmanniae conquitae, Radix Ligustici walchii, and grinding them into powder. The powder is mixed with honey to make pills the size of a "Chinese parasol tree seed". The pills are taken 4 to 6 twice or thrice per day for about 6 months. The alopecia pills and information of the same can be obtained through the Net at chiherbs@primenet.com. The pills are fairly inexpensive $2.75 a bottle (100 per bottle). That is about $15 per month. Stores may sell a similar preparation under the name of Shen Min Hair Nutrient. You may also want to review the definition of Trichogen elsewhere in this Dictionary.

The accupuncture practiced by Chinese medical professionals involves several different steps. First, the practitioner applies a lotion to the scalp. The lotion contains herbs (mostly ginger but Westeners use cedar, sesame, olive or eucalyptus oils) in ethyl alcohol. Ginger contains phenol, a chemical compound previously used in the treatment of alopecia areata. Phenol acts as an irritant and may increase blood flow to an area. These are massaged directly into into the scalp where hairloss is occurring once or twice daily.

Next, the practitioner use a tooth pick or needle to poke on the AA patch without piercing the skin. Traditional accupuncture uses a "7 star needles" that looks like a hammer with 7 needle but has a flexible handle. This instrument is also called a Chinese dermal hammer (a small hammerlike device, usually made of lightweight plastic or metal which has one end a simulated hammer about a half inch in diameter with many fine protruding needles (OUCH). This instrument has also been used in other dermatological conditions including psoriasis, eczema, certain rashes and wrinkles.

The scalp is tapped slightly with the 7 needles especially around the edges of the lesions. The poking effect may, again, be similar to other irritants been used on AA. It is used to "awaken the nerves" and improve blood flows. Lastly, the practitioner presses his thumb hard on the AA patch and rocks his thumb for a few minutes without pulling out any hair. This, again is again done to improve the blood circulation. Overall, visits should cost between $10 and $30. Anybody trying to slap a $50 tab on you each time are way over priced. Treatment may last anywhere from a few weeks to a few months depending on the severity of the condition.

There is an interesting article detailing the use of traditional Chinese herbal therapy in atopic dermatitis. As you are already aware AA and atopic dermatitis are often seen coexisting in the same patient. The study reported clinical improvement of the condition but pointed out that given the number of herbs and different active ingredients it was difficult to discern a mechanism. The authors also found that their concoction was potentially toxic and could produce liver damage. (Sheehan M, et al, Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis. Lancet 1992, 340:13-17).

Another use of Chinese herbal therapy is in restoring hair pigmentation (e.g., premature graying). The use of He Shou Wou supposedly nourishes liver and kidney essence thus making the hair darker. The name of the herb comes from an ancient story of a famous military leader who was condemned to death by confinement in a remote cell without any food or drink. He was able to survive by consuming the leaves and roots of an accesible vine-like weed (polygonum multiflorum). After one year his keepers went back to collect his remain only to find him completely rejuvenated with lustrous black hair. Since that time the herb has been named in his honor (He Shou Wou). The herb may be found as an ingredient in a patented formula called "Shou Wou Chih" or Fo Ti. Another remedy for restoring hair color is black sesame seeds (one tablespoon daily). The seeds are roasted and ground with salt to make a condiment or mixed with honey or powdered sugar for a sweet version. See the article Integrating the traditional Chinese understanding of the kidneys into Western herbalism by Michael Tierra for more information (especially section 8).

Note: The terminology of Chinese herbal remedies may be somewhat confusing. Fo Ti, Shou Wu, He Shou Wu, Radix multiflora polysomething or other... are all the same. Trichogen and Shen Min contain Shou Wu (amongst other ingredients.)

Chlorine
Poorly controlled chlorination or bromination of swimming and spa pools may produce skin irritation. This may be accentuated in a person who already has dry skin/eczema, i.e., many people with alopecia areata. Also, lime, magnesium and iron from hard water that are deposited in skin fissures may produce mechanical irritation.

Fitzgerald DA, et al. (1995) Spa pool dermatitis. Contact Dermatitis 33:53.

See also section 6: How do I take care of my skin?

Cimetidine (Tagamet)
An anti-histamine used primarily to inhibit gastric secretions in people with ulcers. It has been used as an adjunct in the treatment of alopecia areata for those patients that have developed tolerance to the effect of topical irritants, e.g., SADBE. The results of this approach have been mixed. Cimitedine also has antiandrogenic properties and has been used for androgenetic alopecia. At higher doses, the antiandrogenic effects may lead to enlarged breasts or sexual problems. Paradoxially there have been sporadic anecdotal reports of cimetidine itself causing hair loss. Headaches, dizziness and mild diarrhea are potential side effects. Older people and those who are very ill may experience depression, mental confusion or disorientation. Tagamet may also affects the liver enzymes.
Clinical trials
Clinical trials are the way of testing drug safety, efficacy, and pharmacology. Thus far many of the clinical trials on alopecia lack originality and recapitulate failed ideas of previous decades. My feelings on this subject are exemplified in a short play entitled "Darwinism and Clinical Trials on Alopecia."

I am sitting at the breakfast table reading my newspaper when a picture on the first page draws my attention. A young distinguished scientist was caught performing fraudulent clinical trials and is being sent to prison. Fifteen years in jail and 15 year probation has been the harsh sentence. A plea bargain has allowed him to retain some personal possessions otherwise disputed under the Ricco statues.

I raise my eyebrows. Uhhmmmff.

A hazelnut aroma suffocates me. I pause to sip discretely the coffee that my wife has placed in front of me.

"The details of this remarkable schme have been found within the archives of the FDA", quotes the newspaper.

I wipe my lips with a handkership that had been tucked in between my wallet and my pocket.

"The FDA is an ancient organization originally derived from the Fumbling Dictographers Association. It was a group of federal employees that because of their tenure could not be fired but, rather, were clustered together and isolated from otherwise better employees. The incept was based on the dictum, "if you can't fire them, give them good recommendation so that they can move to another job."

The organization was charged by President James Garfield with the responsibility of copying a series of Spanish transcripts that dealt with the history of malaria. Unfortunately the President was assasinated before seeing the end result of his mandate. Unable to read or speak Spanish, the FDA labored at copying over and over the original text and misattributing its authorship. The recreated text gave rise to Gorjas manuscript on malaria. By means of a singular series of mistakes the text was transformed to an epistolary narrative on polio. Eventually, accumulated errors gave rise to the use of steroids in alopecia. Sensitizers and irritant were different interpretations for a term the FDA had originally translated as skin tenderizer."

I sit, amazed by the newspaper account. No wonder I always confused DPCP with DNCB. SABDE was just more gibberish.

I felt sorry for the investigator that was sent to jail. The FDA in mistranslating the original text may have inadvertently attributed authorship to the wrong person.

I signal my wife with my hand to call her attention. "You see Gisela," I said imperturbably, "Although there are many clinical trials in alopecia they are all rehashed versions of one that never even attempted to find a cure for the condition."

Teaching point: Wouldn't it be nice if the cure for alopecia is found from experiments designed to treat or cure alopecia rather than high blood pressure, prostate dysfunction, glaucoma, organ rejection, etc?

Cloche hat
A cloche hat fits close to the head and has no brim. Think of a 1920's Betty Boop "flapper" look. It's different than a "kettle" hat which generally has a larger look and is a different shape. Cloches mirror the shape of the head.
Comb
Be carefull when selecting or using a comb for your hair. Hair is easily elongated and fractured when wet. Use your fingers and dry your hair before detangling with a comb. When buying combs and brushes select them with widely spaced teeth or bristles so they are better able to glide through your hair. Those styles having rounded tips are best for fragile hair. These qualities (wide spaces and rounded tips) in a comb or brush are far more important than whether they are made of synthetic or natural materials.

The following is an excerpt, loosely translated, from a TV news broadcast in Turkey:

“A catastrophic event would nearly happen in Bulgaria when the Head of the Balds' Association was caught with a COMB in his pocket. The man was going to be removed from the Association as it was forbidden to carry a comb according to the rules of their association. The man could only convince the members not to remove him by saying that he was carrying the comb for his moustache!”

Complement system
The complement system primarily gets activated when antibodies react with their antigen. This is a primitive system of defense that leads to the elimination of the offending agent, e.g., if the antigen-antibody are located in the surface of a bacteria, the complement system results in the lysis (makes them burts) of that foreign invader. The usual mechanism by which they cause death is by either phagocytosis, attracting neurophils (a type of white blood cell) or promoting an inflammatory response. Thus far, scalp biopsy studies of patients with AA have shown a lymphocytic infiltrate around the base of affected follicles, neutrophils are largely absent, there is no apparent cell necrosis (the cells in the hair follicles remain dormant not dead), and evidence for an antibody mediated reaction is scant or contradictory. I don't believe that the complement system is a primary player in the pathophysiology of AA.
Complete Blood Cell Count (CBC)
The enumeration of the various elements of the blood, i.e., red cells, white cells, and platelets. Manual methods have been supplanted by automated techniques which provide both the total numbers for exact type of cell as well as their morphological indices. The CBC is usually reported with the hemoglobin and hematocrit.
Compliment
They are "halos" of human hair which sit on the head. These compliments weigh a little over an ounce each. They simply sit on your head, encircling it like a wreath. You can wear several of them at a time. They are of primary use for females with androgenetic alopecia who have enough hair to hide the string they are hung on. You can obtain more information on hair compliments from Maria Posa at Hair Compliments in Strongsville, Ohio at (216)238-9779. You can order them by phone if you have already measured the circumference of your head. If you have almost no hair you would probably need three halos- but the more the merrier for a thick lush look. If you have absolutely no hair, you would put a hat on top of your head with the compliments. Each halo is made from European human hair and cost about $150. If you buy two, Maria usually throws in a third one for free. They may be died to any color you want.
Compresses
A wet dressing soaked in cool tap water and applied to affected skin. sometimes aluminum acetate, saline, or potassium premanganate are mixed with the water. The compresses are applied for a period of some 10 to 15 minutes and changed every 5 minutes to ensure their wetness. Compresses have been used primarily as anti-pruritic, anti-inflammatory, and cooling. They are particularly effective in eczematous conditions.
Conjunctivitis (Allergic)
Some people with asthma, eczema or hay fever also suffer from allergic eye conditions. These allergic eye conditions usually become apparent before the age of 30 years. Characteristic symptoms include itching, sensitivity to light, and inflammation of the eyelids. Symptoms may worsen when exposed to ocular irritants such as smoke and to certain foods or food additives. Treatmen consists of avoiding any offending allergens and systemic antihistamines. Topical antihistamins are used in conjunction with vasoconstrictors to reduce the redness in the eyes but prolongued use of these preparations may by itself induce a type of contact conjunctivitis.
Connective tissue
The group of cells that together provide the support elements of organs.It is primarily the extracellular matrix that provides a given organ its 3D shape. Many decades ago they were considered passive in nature but now research has shown that they play an active role in organizing the cellular architecture of organs, exchanging signals, etc.. Since collagen is the most abundant protein within connective tissue, these conditions were also known as "collagen disorders". This was obviously a misnomer since connective tissue also has elastin, glycoproteins, etc.. At present the term collagen disorders is restricted to inherited conditions shown to affect the synthesis or expression of collagen. Among the collagen disorders we now find Ehlers-Danlos syndrome and osteogenesis imperfecta. Rheumatological conditions are most prominent in the acquired connective tisue disorders. Systemic lupus erythematosus (SLE), Sjogren's syndrome, rheumatic fever, ankylosis spondylitis, progressive systemic sclerosis, polymiosistis, dermatomyosistis, amyloidosis, rheumatoid arthritis are among the common connective tissue disorders. Many of the aforementioned connective tissue disorders are of autoimmune origin and may be seen in conjunction with alopecia areata, totalis and universalis. The fact that they are not benign/innocuous is what prompted me to do research regarding my daughter's condition. I cannot quote epidemiological data showing the incidence or prevalence of these conditions in patients with alopecia areata and similarly I cannot predict who will or will not develop the condition.
Contact dermatitis
A reaction in the skin due to contact with a material such as metal, etc. Virtually any chemical has the potential to cause an allergic contact dermatitis. Among the most common offenders are nickel (jean studs, bra clips), rubber compounds (shoes, gloves), Balsam of Peru (perfumes), wool alcohols (lanolin), and poison ivy/oak. Although most erruptions develop 24-48 hours after contact, others take up to 7 days for their manifestation.
Copper
Nutritional deficiencies of this element (as in some inherited metabolic conditions) result in loss of hair color and malformed kinky hair.
Cooties (koo' tees)
Cooties are supposed to be little tiny bugs (lice and nits), often imaginary, that live on hair shafts. When I was little (waaaaay back when), we used to make these little paper things in class that were cootie catchers. Depending on which way you opened them, the inside was either white or speckled with little black dots. One approached a friend's hair with the white side out and then turned it so that it appeared to be filled with little "cooties." What fun we had in 4th grade! Be warned however that cooties ain't cuties. Scientifically speaking the method of transmission is through contact with an undesired person (ie, social outcast, a girl if you are a boy, a boy if you are a girl, sibling, etc.). Cooties are just one of the things that make my life miserable. It is because of cooties, that my children can not sit near each other. They may not breathe on each other.... and according to my kids, if they look at each other, they will get cooties!! And heaven forbid if one of 'em touches something of the others. OH NO!! Cootie alert!!

Well there is one advantage of not having hair; you can't get the cooties. Otherwise if you have them, treatment is easily instituted through the use of lindane (Kwell) or "synergized pyrethrins" such as R.I.D. An alternate therapy may be a very painful innoculation. Sometimes a shoulder punch will work, but the proven method is a good hard pinch. Corticosteroid injections, as always, exacerbate the condition. Is there a point in being weird about things that don't exist? Well, maybe just in having fun. (Hopefully this dictionary and its definitions are cootie free!)

Corticosteroid
A drug (steroid) used clinically to suppress inflammation of the tissues.
Corticosteroid "Addiction"
A recent article written by K Wells and RT Brodell and entitled, "Topical Corticosteroid "Addiction" (Postgraduate Medicine 93:225-230, 1993) raises some concerns for people using topical steroids. The article details several cases where the use of potent corticosteroids in areas of high absorption (e.g., face/eyebrows for patients with alopecia areata) lead to acne and streak-like dilatations of the small blood vessels (called telangiectasias). The symptoms were controlled with renewed corticosteroids but flared up every time they were withdrawn. Each time the flare ups came with renewed vigor. In the end it became apparent that corticosteroid, although arresting momentarily the symptoms, made the condition worse over the long run. The authors suggest avoiding the use of long term prescriptions of corticosteroids and avoiding the use of very powerful agents in these susceptible areas. They suggest that psychological support may be necessary in order for the patient to break their "addiction" to topical corticosteroids.

The whole point of the article is that fairly innocous application of steroids may be absorbed even when they are not injected. I have heard that a clove of garlic under the foot inside your shoe will soon start to smell on your breath. I haven't tried it myslef but if this were the case it would attest to the absorbance capacity of the skin.

The article by Wells and Brodell suggest a similarity between the flare ups of the conditions treated by topical steroids and alopecia areata. It is apparent that after repeated aplications, the steroid controlled the immediate manifestation, but ended by making the underlying condition worse in the long run. An interesting point (as basic as it sounds) is that at present we don't have a study comparing the long term outcome (20 years down the road) of patients treated with steroids vs. those that didn' receive them. Who knows maybe the majority of our participants never recovered because of the aggresive treatment they may have received early in life? Maybe those that didn't receive medication have recovered and therefore are not within our list server. These are emphatically a concatenation of loose ideas but may serve as food for thought.

Couvre
The name Couvre I believe is the French term for cover. Couvre is a colored cream used as a waterproof cosmetic to fill in the bald spots on the scalp. It temporarily (until wash out) covers the light shiny scalp and blends in with the hair color therefore giving the appearance of more hair since there isn't any distinction obvious between scalp and hair. It costs about $20/tube. The 800 telephone number to order is 443-4521 or you can email them at couvre@couvre.com. The company will send you a number of photographs of color of hair for you to match. It is also available through Doctor Leonard's Health Catalog, 1-800-785-0880, for $14.99. Ask for item #56044 and tell them what color your hair is so they send the right color.

Couvre works well and makes the bald patches less conspicuous if you have hair to comb over the bald spots. Presumably the product is safe to use even if you are already putting some kind of topical medication on your spots.It doesn't run, even in the rain, even in the shower, even if you sweat. It needs to be washed off with shampoo or soap. Some people apply it by rubbing it onto the salp with a couple of fingers although it comes with an applicator sponge. Wash your hair, comb it out and then apply the Couvre before blow drying. It is somewhat messy and will stain pillow cases and sheets if you don't wash your hair before bed. Also, if you don't wash your hands with soap after application then it rubs off on whatever you touch.

Some people have also used mehndi tattooing as a way to cover the bald spots. The method only provides for temporary results. You can read more about mehndi in section 5 under Wig Alternatives.

Creams
Creams are emulsions of oil-in-water. In a cream, the oil droplets of natural or semisynthetic glycerides, petroleum products, waxes, sterols, volatile oils, or silicones represent the discontinuous phase and are dispersed in water or a polar liquid as the continuous phase. Oil-in-water creams are completely miscible with the skin oils and absorb water, but they are not necessarily water soluble because of their oil content.
Crepe hair
Woolen strands stained in different colors to imitate a braid of human hair. The strands are pulled from the braid and glued to the scalp with adhesive in order to camouflage small patches of hair loss. The process needs to be repeated after each shampooing or after removing the orignal scalp adhesive with a specially formulated product.
Crohn's disease
A form of inflammatory bowel disease that follows a chronic, unpredictable course. Patients with Crohn's disease experience abdominal cramping, tenderness, diarrhea- joy, joy, joy. While it cause remains unknown, research has suggested genetic, immunologic and psychological factors (sounds familiar, doesn't it?). The condition is well known to have extraintenstinal manifestations but primarily to the joints. The skin has also been involved, at least two case reports have correlated Chron's disease and alopecia areata. Therapy is based on avoiding all products containing gluten. Gluten is found in wheat, rye, oats and barley. People with Chron's disease have to avoid food containing flour, cereal products, hydrolized vegetable protein, malt, and starch. A diagnostic test can be ordered based on the presence of anti-gladian antibodies.

Searching medline I found a recent article which from the title sounds like eliminating gluten does not always result in regrowth of hair:

Bondavalli P; Quadri G; Parodi A; Rebora A. Failure of gluten-free diet in celiac disease-associated alopecia areata [letter]. Acta Dermato-Venereologica, 1998 Jul, 78(4):319.

You may also want to check the following article:

Corazza GR; Andreani ML; Venturo N; Bernardi M; Tosti A; Gasbarrini G. Celiac disease and alopecia areata: report of a new association. Gastroenterology, 1995 Oct, 109(4):1333-7.

Cyanocobalamine
One of the water soluble vitaamins also known as B12. It combines with an intrinsic factor for absorption and is necessary for the maturation of red blood cells. Low levels or absence of the vitamin cause pernicious anemia.
Cyclosporin

“I took cyclosporine pills for 4 months but the result was totaly negative. Now that I haven't taken anything for a year and half I am experiencing regrowth. What kind of crazy contition is this?”

An immunosuppressive agent derived from fermentation of a soil fungi (Tolypocladium inflatum Gams). The drug affects the activity of certain types of immune cells (helper T lymphocytes) without affecting others (suppressor T lymphocytes, B lymphocytes, macrophages, etc.). It has been used extensively in medicine to prevent transplant rejection, less so in psoriasis and rheumathoid arthritis.

Although it has been reported that some severe cases of alopecia areata (including AT and AU) have shown regrowth when treated with the drug, its toxicity prevents widespread usage. Some side effects of the medication include renal failure, hypertension, liver damage, an increased susceptibility to infections, tremors, etc. The concentration of cyclosporin can be increased by drinking grapefruit juice, taking oral contraceptives or calcium channel blockers. As one of our lady participants said you could probably obtain better results with less side effects by putting the hair above her lip (that she bleaches) and the hair between her eyebrows (that she plucks) glued to her forehead.

Cytomegalovirus
This is an infectious agent of the herpes family. It can manifest itself in the presence of normal body immunity or it may capriciously prefer to remain dormant until reactivation. Infections are seen most commonly in the fetus, neonate or immunocompromised host. As the name (megalo) implies the virus is associated with the production of enlarged cells. Transmission usually occurs by contact with blood, but the virus is also present in milk, saliva, feces, and urine. The most common manifestations after the first few weeks of life resemble mononucleosis; fever, muscle pain, fatigue, and sometimes an enlarged spleen. There was a published study using PCR amplificiton claiming a high prevalence of CMV in patients with AA.

The original report by Dr skinner suggested CMV was found in or near hair follicles in people with AA. Dr Skinner tested a small number of skin biopsies and consistently found CMV for biopsies of AA affected skin versus biopsies taken from people with other skin disease. He suggested CMV might be causing inflammation which led to hair loss. There is a seperate report on injection of CMV into mouse skin causing localised inflammatory alopecia around the area of injection.

Three different research groups tried to repeat Dr Skinners findings but failed to identify CMV in hair follicles from their biopsies. I think one group used in situ hybridization techniques and the others examined for DNA derived from CMV. It is thought that Dr Skinner was either just "lucky" in finding CMV in all of his samples or he had a problem with CMV DNA contamination in his laboratory.

D

DEBR rat
An animal model for alopecia areata sustained (but not commecially available) by the University of Dundee. Skin biopsies of affected regions in these animals show the same T-lymphocytic perifollicular infiltrates as patients with alopecia areata. There is another less studied animal model for alopecia areata. It is a mice (C3H/HEJ) selectively reared by Jackson Laboratories. As before, this mice model is not commercially available.
dehydroepiandrosterone (DHEA)
DHEA (real name dehydroepiandrosterone) has also enjoyed an enormous amount of publicity out of the rejuvenation fad. DHEA is at a low level early in life, but peaks sharply at about age 21 and then tails off. By age 85, it is down about 95%.

This is a powerful steroid which may provide the precursor for androgen and estrogen in peripheral tissues. There have been many uses for DHEA reported in the medical literature. Among the ever increasing list are its use to restore immune competence in aged animals, prevent atherosclerosis, in aging (restoring some cognitive functions) inhibit platelet aggregability, prevent cancer, and even as an antidepressant. In the layman press DHEA has been said to promote a sense of well being, improve sexual function and grow hair.

I have some concerns based on the fact that the drug has been tested primarily in animals and we don't know its complete range of side effects. I still believe in one of the laws of physics in that for every action there is an equal and opposite reaction. I believe that you can push the body so far with medications (especially a powerful steroid with a plethora of actions) before noticing serious side effects. One possible scenario is the long term risk for cancer for those tissues that actively respond to sex-hormones, e.g., breast and prostate. If you have prostate cancer DHEA could prove deadly.

Of related interest, rom a recent interview in the London Observer of Drs. Malcom Carruthers and Steven Shalet:

“Testosterone controls virility. Low testosterone equals low libido, reduced sexual performance, lack of vigor and energy, and in extreme cases, osteroporosis and bone problems …

“… in light of this, men can blame their urgent need to disappear off to the pub, snooker hall, golf course or rugby international on their hormones, and anyone unhappy with that will be powerless to protest.”

Unfortunately my wife is never convinced about my scientific explanations for playing golf.

Demodex follicularum (mite)
The mite implicated to cause mange in animals has been reported as present in the hair follicle of those individuals loosing their hair. These mites burrow down in the hair follicle.....my goodness, there's a whole lot of shakin' going on in them there follicles!!!

The mites live on sebum, the oily material that the scalp secretes. The mites are universally present in all humans after adolescence suggesting that alopecia may depend, among other things, on the genetic suceptibility of the subject. The following news release relating alopecia to mites was provided to the UPI during a Dermatology conference in Miami, 1998.

Here's the Official Alopeciac Mite Song:

“I love my jeans, and the way they hug, but my genes,
my genes, my genes got bugs,
There's vermin on my chromosomes, and that's why I'm
a chromo-dome,
OOOH, mites!
Get away from me!
OOOH mites,
Let my lashes be!
They are here to stay
and my new shampoo
washes them away,
but they come back too,
and they make me sneeze
and they make me wheeze,
and they make me do the wig strip-tease,
I'm humbled
by their strength and power
they chew on my hair and oil
every day and hour.
I love my genes, and my grandma's, too,
and I want to know - Grandma? Grandma? OOOH,
why didn't mites do this to you?
Can my neighbor get 'em
if I use her pool?
OOOH mites, mites in my genes.”
Dental problems
Jacquet (French chap) around the turn of this century claimed that alopecia areata developed as a result of dental decay. This was at the time when AA was believed to have a "neuropathic" origin where the nervous system in and around the hair follicles was dictating lack of hair growth. Jacquet believed that the destruction of the nerves in the teeth, as a result of decay, was being transmitted through to the nerves in hair follicles and showed up as hair loss.

However, other dermatologists took his idea and showed by statisitics that dental decay in the general population was just as common as in people with AA (bear in mind that tooth decay was much more common at this time).

Hair, nails, teeth and eyes are all related "organs" although their similarity of structure and cell type is much more obvious in less complex animals than ourselves. Although the link between hair and nails being affected is clear, there has been no evidence to suggest that eyes or teeth are affected in AA any more than in the general population. Most likley for mammals (dogs, horses, mice, rats, primates and cattle can get AA too) teeth and eyes are so differentiated from the hair follicles that they escape the attention of the immune system attacking hair follicle antigens - assuming this is an immune based condition.

Depression
Dysthmia is the word to describe a form of chronic, mild , depression . Most people who have Dysthmia are always kind of low. I always describe it to people that there is this line that is signifies a normal level. A dysthimic person is about 20% lower. So when they feel really good they am more like a regular person and when they are down they are way down.
normal========================================
dysthimic================================
major depressive========================

People with dysthimia are not very happy and kind of blue. Most may not even know that there is anything wrong. They never know exactly what is wrong with them, but always feel different from everyone else. They don't feel the same joy in life as other people seem to be getting out of it. Never feel like they are good enough, don't want to be in public or with other people. They sleep alot and just never have any energy, any positive thoughts about their future, and always see the glass "half empty" as they say. They may have a problem with anxiety also and it makes it alot worse. The only way to explain the feeling is like walking around in a fog all the time. One of the participants within our discussion group didn't realize what was her problem until she was 26 years of age. After being put on medication for the first time, she first experienced what it was like to feel "normal" and what life felt like. It was an amazing transformation for her.

You may many things on-line about it, on-line groups such as our alopecia list server that you can join. You just have to do a little searching. List server are like friends that may help you know when you are kicking yourself around.

The hardest part for some persons looking for help has been the fact that other people don't understand what is happening. Most people think that you can just "snap out of it" NOT TRUE!!!!!!!

Dermal papilla
The base of the hair follicle that helps form hair.
Dermal retention
Insertion of synthetic hair fiber into the scalp is a very dangerous procedure and, I'm told, illegal in all states except New Jersey. The synthetic fibers have a barb on one end that are "punched" into the skin. Eventually they fall out unless they are punched deep in to the skin. When punched too deep the synthetic fiber as a foreign object and can elicit an inflammatory response. Scarring and irreversible loss of remaining hair follicles is possible. I have seen a few horror pictures of people after having these synthetic implants -the inflammation and scarring is chronic and extensive. The syntheticimplants had to be surgically removed. No amount of plastic surgery was going to correct the problems of these unfortunate few. Also, the sites of fiber insertion are potential portals for skin infection.

Artifical fiber implants into the scalp were popular in Japan a few years ago until these problems were recognized. The Japanese manufacturers of the synthetic fiber then claimed that they had solved the problem of inflammation by coating the synthetic fibers with a special polymer. However I doubt that this would truely resolve the inflammation problem and it does nothing to block skin infection via the punched holes in the scalp.

The following may be of interest:

New Jersey Files Suit Against United Micro Systems

In response to a lawsuit filed by the New Jersey Attorney General and Division of Consumer Affairs Director, a New Jersey Superior Court judge has frozen the assets of United Micro Systems ("UMS") of Voorhees, New Jersey.

UMS offers a hair replacement system called "Dermal Retention," about which the state alleges UMS made false and misleading claims in both its internet advertisements and in national magazines.

The suit names both former and current owners and employees as defendants. Camden County Superior Court Judge Theodore Z. Davis has ordered the defendants to appear for another hearing on May 18 to respond to the states allegations.

According to the Attorney General, UMS and the defendants "...lured men and women into purchasing their product with unsubstantiated claims about this so called 'hair replacement system' and then turned their backs on the victims when the product failed... We cannot and will not stand by while salespeople allegedly take advantage of trusting consumers. That is why we're taking action in this matter."

Complaints in the case by consumers range include high cost (as high as $8,000), misleading the public by calling the hair replacement "permanent", and that the hair systems did not look natural and came loose within days.

Several UMS employees are also former employees of another New Jersey company called International Cosmetics Laboratories, Inc ("ICL"), which marked a fradulent treatment for baldness called the "cosmetic suture process." ICL was prosecuted by New Jersey Consumer Affairs in 1994 and eventually went bankrupt.

The formal charges against UMS by the state include:

Falsely claiming that Dermal Retention was permanent and that it created "an individual hair effect"; UMS promised that the hair replacement process would look natural and create an undetectable hairline; Misleading before and after photographs were used in its promotional materials. UMS promised consumers that their product was warranteed and had a satisfaction guarantee which were not honored.

Dermatitis
The terms dermatitis and eczema are used interchangeably. Dermatitis can be acute or chronic. Acute dermatitis refers to a rapidly evolving red rash which may be blistered and swollen. Chronic dermatitis refers to a long-standing irritable area. Factors which may result in dermatitis include contact with irritants, allergens, inherited factors, dry skin, injury to the skin, and infection. An important aspect of treatment is to identify the contributing factor and then treat it. Topical steroid creams can be applied to itchy patches for a 5 to 15 day course. Dermatitis is often a long-term problem. If your skin gets dry, moisturize it and be carefull with the amount of soap you use. Consult a dermatologist if symptoms persist for two weeks with no signs of improvement.
Dermatoscope
A hand held lighted magnifier/microscope. Some Dermatologists find it useful in looking for exclamation hairs (see dictionary section), shaft diameter to diagnose andrgenetic alopecia, to evaluate scarring, etc. It is great to be able to see the hairs in their nascent shape and the know how they will grow soon.
DHT
The abbreviation could stand for Dustmites Have Teeth, Dentists Hate Teens, Don't Have Tomatoes, or dihydrotestosterone. Within cells, testosterone is metabolized to DHT by the enzyme 5 alpha reductase. Too much DHT may propititate development of androgenetic alopecia while growth of hair in other parts of the body is accelerated (e.g., extremitites, anterior chest, etc.)
Diet
This is a catch 22 question, should I emphasize proteins in my diet or should I try to avoid the same? Hair is sensitive to protein deficiency causing it to loose its pigmentation and become thin, sparse and easily plucked. Some people attribute this early effect to the body's natural wisdom, namely, trying to conserve protein for more important functions such as heart contractility. On the other hand, a diet too high in proteins may be harmful to your health. Carbohydates and fats can be metabolized to create energy out of them (in terms of high energy phosphate bonds) but proteins can neither be stored (you can't store muscle) or metabolized to obtain a substantial amounts of energy. The oxidation of proteins promotes the formation of free radicals which go on to injure cells. Oxidation and free radicals is the injurious mechanism underlying the inflammatory respone seen at the base of the hair follicle in patients with alopecia areata. It is therefore not surprising that Dr. Andrew Weil, a natural medicine advocate, recommends the following diet for patients with autoimmune conditions:

Eat a low-protein, high-carbohydrate diet. Eliminate milk and milk products, including commercial foods made with milk. Minimize consumption of foods of animal origin. Avoid polyunsaturated vegetable oils of all kinds. Most importantly, supplement the diet with a program of regular aerobic exercise. For more information on diet and other health concern issues you may visit his site at http://www.drweil.com.

Discoveries in medicine
A recent scientific claim that: HAIR LOSS IS CAUSED BY TOOTHBRUSHES. Cleveland: "A toothbrush is a breeding ground for a microbe that attacks the user's follicles, making hair fall out, says Dr. Wilma Berfeld, a dermatologist in Cleveland, Ohio. A follicle is the tiny gland at the root of each hair. The toothbrush-borne microbe causes an infection called folliculitis. For those worried about contracting folliculitis, Dr. Berfeld said the condition could be avoided by buying a new toothbrush every 30 days or sterilizing the old one in detergent in very hot water." After this important scientific contribution most (but not all) of our participants stoppped their obsessive habit of brushing their scalp with a toothbrush. Just to be fair, even seemingly ludicrous scientific assertions have a long track record in medicine. Thus there are previous reports of alopecia areata and homolateral headache due to an impacted superior wisdom tooth (M Romoli and G Cudia: International Journal of Oral and Maxillofacila Surgery 16:477-479, 1987) and another similar article advocating dental therapy for alopecia areta (S Zivkovic: Stomatoloski Glasnik Srbije (a SerboCroatian journal) 37:299-305, 1990).
DMSO
Dimethyl sulfoxide (DMSO) is an inert dipolar aprotic solvent. It is a powerful hydrogen bond acceptor and forms highly ordered structures with water. In all therapeutic forms of DMSO (oral or topical), DMSO is metabolized to DMSO2 (dimethyl sulfoxide) and DMS (dimethyl sulfide). The kidney excretes DMSO2 and it is eliminated in the urine. The lungs excrete DMS, which gives the breath the characteristic garlic-smell (Wood, 1971). Its therapeutic uses are based on its ability to enhance the penetration of biologically active substances when these are applied to living tissue. However, there have been some adverse effects associated with the use of DMSO therapy since the FDA-approved clinical trail began in 1964, including; erythema, pruritus, urticaria, and a slight increase in local skin temperature.
DNCB
DNCB (1-chloro-2,4-dinitrochlorobenzene) is an industrial photochemical and sensitizing agent. A description of its use is missing from the Physician Desk Reference (PDR) manual because it is obtained as a chemical (rather than as a drug). DNCB has been effective primarily in the treatment of warts but its use has fallen into disrepute when it failed the Ames test. Dermatologists with some experience as to its use are divided as to its efficacy. When applied topically, DNCB causes a reaction similar to poison ivy. In some cases the reaction can escalate to that of a severe burn. There are several ongoing trials about the effectiveness of this drug in treating HIV. From Project Inform DNCB Fact Sheet (http://www.projinf.org/fs/dncb.html): "There are no established label or drug indications for the use of DNCB as a medicine, nor are the currently marketed preparations made under established GMP (Good Manufacturing) conditions."
Dystrophy
Inadequate development.

E

Echinacea
A common plant on the praries (Purple Cornflower). The part that is used for hair growth purposes is the woody stem, which is either brewed as tea, or shredded and placed in capsules. I am not sure if in order to extract the tincture they soak the stem in alcohol or another liquid. You can grow it yourself. The plant tends to grow several feet tall. Herbalists suggest that the plan boosts the action of the immune system. They recommend taking E. purpurea (rather than E. angustifolia) 3 capsules per day at luch time (when it seems to work best) or15 drops of the fluid extract. A doctor of natural medicine once told me that in high doses, echinacea can initiate alopecia. Since there are other immune stimulating herbs that do not have as many side effects not many people recommend this treatment.

Echinacea is not recommended for people with autoimmune disorders because it boosts production of interferon-gamma (IFN-g) which is a cytokine (chemical messenger) for the immune system. IFN-g is involved in Th-1 responses, which stands for T-lymphocyte helper cells. Th-1 responses are pro-inflammatory/"attack". Conversely, Th-2 responses (still T-helper cells) are "anti-inflammatory" and order the Th-1 cells to "stop attacking". The same thing holds for melatonin. (See Melatonin)

Ectodermal dysplasia:

“I was born with total alopecia, and my daughter was born with partial alopecia. Aside from alopecia we both have some dental abnormalities. Basically we are missing some teeth, and the teeth that we do have don't have the enamel coating. Both of us also have problems with our fingernails-they are rather unusual as they are thick and curve inward-like an upside down spoon. Our sweat glands and tear ducts don't work the way they should either. A person born with two of the things that I mentioned could be classified as having Ectodermal Dysplasia.”

A recent published study has isolated the gene of a condition that manifests itself with baldness. The condition is called ectodermal dysplasia- a condition described by the English naturalist Darwin over 100 years ago. The disorders arise from disturbances in one or more ectodermal structures and their accessory appendages. The absence of, or deficient function of, at least two derivatives of the ectoderm constitutes a form of ED. Each combination of defects represents another type of ED and has a specific name. At least 150 different forms of Ed have been identified. Individuals affected by ED have at least two or more of the following manifestations:

  • Absent or malfunctioning sweat glands. The patient may suffer from dry skin, hyperthermia, and unexplained high fever as a result of the deficiency of sweat glands.
  • Dental anomalies include missing or underdeveloped teeth.
  • Varying degrees of Alopecia resulting from defective hair follicles.
  • Malformed or missing fingers and toes.
  • Malformed fingernails and toenails, to varying degrees.
  • In addition, patients may have poorly functioning mucous membranes, cleft lip and palate, deficient saliva, hearing or visual defects, inadequate eye fluids and tears.

Familial studies suggested it was a disorder related to the sex (X) chromosome. Some 125,000 Americans suffer from the condition. The results of the study suggest that scientist may develop a screening test to detect women who carry the gene or affected fetuses dring pregnancy- other practical applications (especially as it may relate to baldness remain obscure).

Eczema
A group of conditions characterized by an itching inflammation of the skin. In acute stages it is manifested by reddening, edema and vesiculation. In more chronic stages, eczema there is thickening, scratch marks, and changes in the pigmentation of the skin. Common trigger factors include heat, contact with woollen and nylon clothing, detergents, stress and certain foodstuffs.

Treatment consists of avoiding excessive heating in rooms as this increases skin dryness and itching. Woollen and nylon clothing can (if next to the skin) cause irritation and should be avoided. Clothing made from 100% cotton is ideal. Biological (enzyme) washing powders may aggravate eczema and so should be substituted with non-biological detergents. It should be noted that tiredness and emotional stress do aggravate eczema. Foods implicated in allergic reactions include dairy products, wheat, seafood and peanuts. Dietary exclusion should only be carried out under the supervision of a dietician as this could lead to malnutrition.

Interestingly, there is an increased density of house dust mite allergen (Der p1) in the homes of people with atopic eczema. Does increased exposure to house dust mites cause the eczema or is the increased density secondary to the heavy shedding of skin scales on which the mites feed?

The hypothesis that AE improves if amounts of house dust mite allergen in the home are reduced was the subject of a double-blind controlled trial, the results of which were published in the Lancet (Tan,B.B et al, 1996). Active treatment comprised of Gortex bedcovers, impenetrable to the house dust mite (placebo - cotton covers), benzyl tannate spray, a mite killing agent (placebo - water) and a high-filtration vacuum cleaner (placebo- conventional domestic vacuum cleaner).

Although the severity of eczema decreased in both groups, the active group showed significantly greater improvements and it was concluded that the activity of AE can be greatly reduced by effective house dust mite avoidance.

Emollient
Agents that make the skin soft and pliable by increasing hydration of the stratum corneum. The greater the occlusiveness, the greater the decrease in water loss and resulting increase in hydration of the stratum corneum. Petrolatum is the most occlusive and therefore the best emollient. It is often mixed with more cosmetically acceptable materials to produce a pleasant feeling to the skin.
Epilating
A mechanized way of plucking hairs. Hair should be long in order for it to be trapped by the coils of the machine. Best results (less painful) are obtained when the epilating device is used over flat surfaces (arms, legs) as opposed to curved ones (underarms).
Erythrocyte Sedimentation Rate (ESR)
This tests measures the rate of descent of red cells suspended in plasma. Anything that promotes the aggregation of red cells will increase the rate of sedimentation. The ESR is elevated in those conditions characterized by increases in plasma fibrinogen and gamma globulins. The results tend to be non-specific as a diagnostic tool. An elevated ESR has been reported in hyper- and hypothyroidism, in patients taking birth control pills, during pregnancy, and postoperatively. ESR is used primarily to track disease activity in certain conditions such as lupus and rheumathoid arthritis. The test in not valid when red cells have an abnomral shape (e.g., sickle cell disease), hyperviscocity syndromes, and in severe anemia.
Essential Fatty Acids
Fatty acids that can't be synthesized by the body and therefore are required in the diet are called "essential". Some examples include linoleic acid, arachidonic acid, and linolenic acid A deficiency of essential fatty acids (e.g., after prolonged parenteral alimentation) results in dry skin, eczematous changes, poor wound healing, and sparse hair growth with lightening of hair color. There have been many claims as to their possible benefit in reducing high cholesterol levels, prevention of strokes and heart attacks, angina, high blood pressure, arthritis, multiple sclerosis, psoriasis and eczema, cancer prevention and treatment, allergies, and asthma. (See also, flax seed oil and omega 3-fatty acids). (See also aromatherapy).
Estrogen
"Estrogen" is a catch-all phrase for the three most important estrogens made in the body. Estrone (E1) is produced by the ovaries, and also in body fat/muscles/skin. Estradiol (E2) is produced by the ovaries. Estriol (E3) is biologically the weakest estrogen and is a by-product of estrone metabolism.
  • E1 can convert to E2 and E3.
  • E2 can convert to E1.
  • E3 is a "metabolic endpoint" estrogen.

Estrogen is an indirect antiandrogen - it leads to reduced levels of testosterone. Several studies with topical application of estradiol (estrogen) on men with androgenetic alopecia suggest growth promotion of hair, and/or stabilization of hair loss. The particular study I am thinking of is German:

Orfanos CE, Vogels L. Lokaltherapie der alopecia androgenetica mit 17(alpha) ostradiol. Dermatologica 1980; 161: 124-132.

However, the side effects with estrogen could be significant - for men at least - including decreased libido and, um, growth of breasts plus increased cancer risk.

Looking at AA the story gets more complex as estrogen also has a role to play in the immune system. CD8 T cells (which are destructive cells found in large numbers in/around AA affected hair follicles) have estrogen receptors and are stimulated into action by higher levels of the hormone. Estrogen also promotes proliferation of B cells and production of immunoglobulin. That might suggest estrogen blockers could be of some use in AA assuming these cell types are causing hair loss in AA. However, IMHO estrogen levels are not of fundamental importance in AA (that does not exclude a role for them though) plus, given the side effects of estrogen blockers, their future does not look too bright. Abnormalities in estrogen metabolism, have been reported in other autoimmune disorders, including lupus, rheumathoid arthritis and multiple sclerosis.

Eucaderm
The Eucaderm product is sold by David Satchell. If you decide to buy this product please get it from Mr Satchell as it will prove to be 8 cheaper ($12). Mr Satchell did have alopecia and is very knowledgeable on the subject. I believe he may be trichologist (See trichology in dictionary section). Here is the contact information:
Eucaderm Ltd 7 West Terrace Eastbourne, East Sussex BN214QX England TEL +044 1323645164 e-mail hair@mistral.co.uk

It is apprently great if you have psoriasis or eczema but of all of the list server members that have reported using the product for alopecia, none have reported positive results.

Eucalyptus oil

“Finally, an update on the eucalyptus oil. The oil did indeed help to soothe the stinging and itching of my scalp, but as much as my husband and I both find it to have a pleasant aroma, it was much too overpowering to use in oil form. I have switched to Dr. Bronner's eucalytus soap in diluted form and am using it for shampoo. The shampoo controls the itch quite nicely. The stinging sensation had actually stopped after I first tried the oil and much to my surprise I find that I now have some pigmented hair growing in the areas that were stinging so much.”

Eucalyptus oil (liquid or in a bar) is readily available in health food stores. Very reasonably priced too; affordable for any pocket book. It is used because fleas and ticks are repelled by eucalyptus. (See Journal of Allergies and Clinical Immunology, Oct., 1997) (See Demodex follicularum).

Kiehl's is now making an Eucalyptus Liquid Body Cleanser. As with all Kiehl's products, it's probably not cheap but good quality. You can call Kiehl's at 1-800-KIEHLS-1 for the store closest to you, or a catalogue. It contains the fragrance but not much of the oil per se. Eucalyptus oil is used topicaly never internally.

Exclamation hair
The tapered club hairs that remain in the follicle after the hair shaft breaks. Using scanning electron microscopy the hair fibers falling out from the edge of an expanding bald patch can look very unusual. Frequently, the part of the hair fiber furthest away from the scalp (the oldest part of the hair) looks normal. Closer to the scalp (newer part of the hair) and it can look quite aberrant. We find the shape of the fiber becomes increasingly irregular the closer to the scalp we look. This involves deposits of disorganized keratin and constrictions in the hair fiber. The cuticle can be missing and there can be longitudinal cracks along the length of the hair. Analysis of the hair fiber shows the constituent keratins to remain the same but the way they are assembled to make up the fiber becomes increasingly abnormal.

The irregular construction of the hair gives it weak spots where it can readily break off. This gives rise to the stumpy hair fibers called exclamation mark hairs that can often be seen in expanding patches of AA. This increasing irregularity of the hair fiber reflects the increasing influence of the inflammatory infiltrate through time. Eventually the inflammation builds up to such an intensity that the hair follicle finds it impossible to make any real hair fiber. Breakage usually occurs some 3 to 4 mm from the scalp. Often the broader distal edge tends to be normally pigmented while the proximal edge (adjacent to the scalp) appears paler. Exclamation hairs are not diagnostic for alopecia areata and may be seen in several different conditions including chemotherapy.

Experimental subject's bill of rights
(See also Clinical Trial)

These rights include but are not limited to the subject's right to:

  1. be informed of the nature and purpose of the experiment
  2. be given an explanation of the procedures to be followed in the medical experiment
  3. be given a description of any attendant discomforts and risks that may be expected
  4. be given an explanation of any benefits to the subject reasonably to be expected, if applicable
  5. be given a disclosure of any appropriate alternatives, drugs or devices that might be advantageous to the subject, their relative risks and benefits
  6. be informed of the avenues of medical treatment, if any available to the subject after the experiemnt if complications should arise
  7. be given an opportunity to ask questions concering the expriment or the procedures involved
  8. be instructed that consent to participate in the medical experiment may be withdrawn at any time and the subject may discontinue participation without prejudice
  9. be given a copy of the signed consent form
  10. be given the opportunity to decide to consent or not to consent to a medical experiment without the intervention of any element of force, fraud, deceit, duress, coercion or undue influence on the subject's decision.

F

Fibroblasts
Fibroblasts are the connective tissue cells of the body. They produce long strands of proteins that act as fibers in tissues. In the skin they produce collagen, reticulin and other elastic fibers. Although the exact role for all of these proteins is not necessarily understood they seem to provide some of the elasticity and leather-like toughness to the skin. At the base of the hair follicle fibroblasts may help to preserve the 3-dimensional conformation of the dermal papilla (the small invagination at the end of the hair bulb). Ultrastructural studies using electron microscopy in biopsies from patients with alopecia areata have also shown irregular profiles and distorted nuclei in fibroblasts. It is therefore one of the cells (among many others) that has been incriminated as pocessing the antigen against which the immunological reaction is directed.
Fibromyalgia

“My hair is just about totally gone, and I have muscle spasms, I can't sleep properly, e.g.; fall asleep about 2-3:00 A.M. and up at 6:00 A.M. for work, this is daily. I am tired all the time, I am very depressed, yet I seem to be moving to fast.”

Fibromylagia referes to chronic and widespread musculoskeletal pain. It is associated with disturbed sleep, anxiety, depression, chronic fatigue syndrome, irritable bowel... (does the list sound familiar or do I need to keep on going?). To top it all, fibromyalgia has been know to antecede hypothyroidism. (See fibromyalgia under Section 6 Other Problems).

Finasteride
A 5-alpha reductase inhibitor that works by reducing the levels of dihidrotestosterone. It has been approved for marketing within the USA for men with androgenetic type of alopecia. Women are warned against using the compound because of its teratogenic effects. I think there is a potential for ambigous genitalia (hermaphroditism). Side-effects of the medication in men include loss of sex drive and impotence.

Finasteride was previously used for prostate conditions at a 5 mg dosage. I haven't read any resuls from long term studies with the drug, the package insert only details results at 24 months follow-up (17% of treated patients had hair loss versus 72% of those in the placebo group). The experimental design for the Finasteride trial differes markedly from that of the monixidil trial making comparison difficult. Thus far there aren't any indications for its use in alopecia areata/universalis.

Flax seed oil
This is a "delicious" oil of deep gold color that can be added to almost any type of food as an important source of omega 3 fatty acids. Different brands may have different tastes. If using it on a salad, mix it with another oil, so you don't get that straight flaxseed taste. It can't be heated over the boiling point of water without its beneficial properties being destroyed. It must therefore be added to food after they are cooked. Flax seed oil is found for sale near the vitamin section of most health food stores in a dark bottle within their refrigerator. It is only good for about 6 months and comes with the date of pressing printed on the side of the bottle. It must be kept refrigerated and should never be left sitting out in the sunlight or exposed to air by leaving the top off- otherwise it can become rancid very easily. If your local health food store doesn't have it, they can order it for you. A good web site for ordering and obtaining some information on the product is www.barleans.com. Omega has a wonderful catalog with all kinds of tips throughout--the phone number is 1-800-661-3529. In the Omega catalog, they give a suggested dose table, which is 1 tsp of oil per day for every 35 lbs of body weight. Another interesting table in their catalog shows which oil to use for whatever temperature of baking, cooking, sauteing, etc. you are doing. The catalog is free and well worth it.

You can also obtain your recommended supplementation of omega 3-fatty acids from the flax seeds themselves. Buy whole flax seeds and keep them refrigerated. Take enough for one week supply, grind them in a coffee grinder or blender, and take two spoons daily.

Omega 3 fatty acids (see dictionary for a definition) are not used as energy by the body as are most oils nor are they stored very much in fat cells. Rather they are used as building blocks for many critical tissues in the body, particularly membranes of the intestinal tract, brain and cardiovascular system. Lack of omega 3 fatty acids causes the body to have to use inferior substances with imperfect molecular structures in an attempt to fill this need and it is little wonder that all sorts of problems can be traced to this.

Flutamide
A chemical that acts as a pure antiandrogen and works by binding to androgen receptors. However, it as no antigonadotrophic effect and the result of binding to central androgen receptors is that it prevents the negative feedback of testosterone and androgen levels increase.
Folliculitis decalvans
This is a rare type of follicular inflammation that leads to cicatricial alopecia. It is characterized by perifollicular pustules, which crust and migrate centrifugally to leave an irregular central area of scarring alopecia with finger-like projections. The disease may be limited to a few patches or extend into a large atrophic bald area. The cause of the disease is still uncertain, but it is possible that a local failure in the immune response or leukocyte function may be the essential abnormality in most cases. Staphylococcus aureas may be grown from the pustules and the abnormal host response goes against these bacteria. Any or all hairy regions may be involved. The scalp alone may be involved or the scalp together with pubes and axillae. There are multiple rounded or oval patches each surrounded by crops of follicular pustules. No other changes may occur, but successive crops of pustules, each followed by destruction of the affected follicles, produce slow extension of the alopecia. Initial therapy during the pustular phase consists of aluminum acetate compresses three times a day, followed by application of mupirocin ointment. To treat the patient, he or she should be investigated for underlying defects of immune response and of leukocyte function as a guide for effective treatment. Systemic antibiotics will often prevent further extension of the disease, but only for as long as they are administered.

G

Genetic pre-disposition
You're more likely to get *it* than the general population due to your genes (GEE thanks mom!!).

An article in Science (279: 720-724, 1998) created some controversy by using an erroneous nomenclature and publicizing having found a gene for alopecia universalis. Although the patients in the article do have universal alopecia, that is hair loss all over their bodies, they do not have "alopecia universalis", a well defined autoimmune condition. The individuals in the article were born without eyebrows or eyelashes. They never experienced any hair regrowth and there was no hair follicle inflammation.

The condition the affected individuals have should have been designated as congenital atrichia. This is a very rare genetic condition that results in abnormal development of hair follicles. It does not involve inflammation of hair follicles as alopecia areata/totalis/unviersalis does. It is probably similar to a condition in mice that have a mutated gene called "hairless". This is not an accepted animal model for alopecia areata or universalis.

Although the genetic research is important in our understanding of how hair follicles are made and grow, it does not have a direct bearing on the inflammatory form of alopecia areata/totalis/universalis.

Shortly after publication of the findings, a new web site (http://cpmcnet.columbia.edu/dept/derm/hairloss/) was created. The site belonged to the Hair Research and Treatment Center directed by the Department of Dermatology of the College of Physicians and Surgeons at Columbia University. The whole purpose of the site appeared directed towards attracting patients to their clinics. No new service was provided, rather, the Hair Research & Treatment Center offered patients a so-called comprehensive evaluation, including: physical examination, history, laboratory tests (as needed), scalp biopsy (as needed), and microscopic evaluation of hair (as needed). These same services can be offered practically anywhere else in this country. The center also provided those interested an opportunity to participate in their clinical trials, many of which are sponsored by pharmaceutical companies. I can probably translate this best by saying that if they don't take the money directly from your pocket, they will charge the pharmaceuticals for the same. What bothered me most, besides their salient pecuniary interest, is the fact that part of their sales pitch went as follows, "Patients of the Hair Research & Treatment Center will also benefit from the recent exciting discovery by Angela Christiano, Ph.D. and her research team in the Department of Dermatology- the first human gene associated with hair loss!" What they failed to mention is how is the discovery directly applied to the treatment of patients coming to their clinics? What is the so-called "benefit?" The short answer is that it can't be applied to patients. Again, this follows the trend of certain researchers in providing misleading information to patients and using inapropriate nomeclature to either promote or publicize their findings.

“He that increaseth knowledge increaseth sorrow.” —Old Testament

Greek medicine (Hygeia and Aesculapius)
Healers in ancient Greece proposed different avenues of treatment for acute and chronic conditions. In order to manage crises and other short term conditions they proposed Aesculapius, that is, the use of toxic and invasive methods to suppress symptoms. Hygeia, or the natural approach to healing, was used primarily for long term or chronic conditions. The natural approach required the manipulation of the physical elements (e.g., water, light, air), herbs, massage, love, etc., to promote healing.
Guided Imagery
A technique that capitalizes on the brain's tendency to spontaneously create images. Guided Imagery (GI) has many uses, among them; the lowering of stress, lowering of blood pressure, lowering body temperature, increasing the number of white blood cells in one's body, and even the killing of cancer cells. For example, a patient with cancer might imagine their white blood cells as Pac-Men eating the cancer cells, as asteroids crushing the cancer cells, or as a giant glob of goo rolling through the body and sucking up the cancer. There have been numerous studies and testimonials in this regard in various scientific journals. One of our members was interested because music is often used to enhance the effectiveness of the images. Anyway, if images of green goo sucking up cancer cells can actually enhance the body's ability to fight the cancer, a case could be built that Guided Imagery could enhance the body's ability to re-grow hair? A history and explanation of guided imagery, actual scripts, and a good bibliography on the subject can be found in Bellruth Naparstek's "Staying Well with Guided Imagery." Guided imagery resources in the Net include: Brain Sync (commercial site), and the article “Guided Imagery in Hospitals?.”

H

Hair additions
The use of synthetic or natural hair to supplement local areas of hair thinning or baldness. Additions may last for up to 8 weeks and can be used while swimmming, bathing, excercising, etc. This technique uses existing scalp hair to anchor added hair by braiding, sewing or glueing.
Hair follicle
The structure(cavity) in the skin responsible for the formation of hair.
Hair pieces
There are seven basic types of hair pieces:
  1. wigs, designed to cover the entire scalp,
  2. cascades, a curled lock or bun of hair that attaches to the posterior portion of the scalp,
  3. falls, a long lock of hair that attaches to the vertex of the scalp,
  4. toupees, a custom fit hair piece that covers the top of the head. This hair pieces is specifically designed for men with common male patern baldness. You may select the color with the appropiate amount of white hairs to match your own. The major disadvantage is the poor attachement that relies on clips or adhesives,
  5. wiglets, small locks of hair that help in styling by creating bangs or covering the top of the head,
  6. demiwigs, a wig that does not cover the front hairline. It is used as a hair thickener by patients having female pattern alopecia, and
  7. switches, a long strand of hair used as a braid or ponytail.
Hair pluck test
The hair pluck test is used as a diagnostic test for alopecia and is helpful in determining whether or not a telogen effluvium is the cause of hair loss. A group of 20-30 hairs is plucked rapidly in the direction from which the hairs emerge from the scalp using a modified needle holder whose jaws have been covered with rubber or plastic tubing. At least 80 percent of follicles are in the anagen phase of the hair cycle in the normal young adult.
Helper cells
A T lymphocyte that recruits other cells (B lymphocytes) to produce antibodies (protection) against foreign substances in the body. Helper cells may also aid in the activiation of suppressor cells (see Dictionary for definition of suppressor cell).
Hepatitis B vaccination
A hair loss study conducted by the FDA on the Vaccine Adverse Event Reporting System revealed evidence consistent with a relationship to the plasma-derived hepatitis B vaccine and the newer recombinant forms. A majority of the patients affected were females. The extent and duration of hair loss and the interval from vaccination to onset of hair loss also varied widely. In nine cases a previous history of allergies was recorded. The authors of the study speculated that hair loss was triggered by vaccine antigens,...either via telogen effluvium or through a novel autoimmune-mediated mechanism." (Wise RP et al, JAMA 278:1176-1178, 1997).

The following details some highlights of the article:

Case Description, Patient 1. A 12-month-old white female infant in California began to lose scalp hair 10 days after her second immunization with hepatitis B vaccine (HBV). During the next 3-months she progresses to complete baldness, but regrowth was complete by 18-months. Approx. one week after her third dose of HBV, given with oral polio vaccine (OPV) at the age of 18-months, her parents noticed recurrent hair loss, which again progressed to near total hairloss and which regrew beginning at the age of 2 yrs. Extensive medical evaluation failed to identify a cause. Her physicians considered, but discounted, the possibility that recent vaccination might have contributed since she had experienced no adverse event after her first dose of HBV at the age of 10-months, and there was NO suggestion in the medical literature or product package labeling that hair loss might follow vaccination.

(Note: the JAMA article does not identify the child (pt 1), but I'd bank on it that it was little McKenna White. She and her family were featured in an article that ran in the San Francisco Chronicle, April 21, 1994. According to that article, a nurse for the attending physician, called Smith Kline Beecham, the manufacturer of the hepatitis B vaccine (Merck & Co. is the other one) and she was told that other cases of alopecia associated with the vaccine had been reported. After learning that, they contacted the Centers for Disease Control and Prevention and were told nine cases of alopecia associated with vaccinations had been confirmed by a computerized reporting system. In contrast, however, to the JAMA statement above, in the newspaper article McKenna White's pediatrician DID think her hair loss was caused by the vaccine.)

Here was the breakdown for the 60 cases in the article (remember the problems above):

  • 4 showed clear evidence to vaccines (3 HBV, 1 other vaccines)
  • 12 were listed as possible (11 to HBV alone)
  • 44 fell under the other only category listed which was “no or unknown”

What else was wrong with this study and/or why is it ongoing? Out of 52 states, only 20 had reported any adverse events relating to alopecia. California alone reported 20 adverse events out of a total of the 56 reports that came in. Why were so many reports coming from that one state? Because the initial publicity surrounding onset for alopecia and vaccines began in San Francisco. In that one area, following the McKenna White newspaper article, 5 more cases were reported.

Before I get off my soapbox, I'd like to make a recommendation to our members here who suspect onset with vaccines. Pick up the phone NOW and call the Food and Drug Administration (FDA) at 1-800-FDA-1088 where you can speak to a real live human and request a MedWatch form be mailed to you which you will complete yourself (keep a photocopy). Or, you may also call the FDA Vaccine Adverse Events Reporting System line directly (1-800-822-7967) and leave your name, address and phone number for a form to be mailed to you. Both numbers accomplish the same thing; the second phone number is completely automated. Don't wait for yours or your child's doctor to report it; they may think (just like the alopecia "experts" at the conference) there's no conclusive evidence to support what you are thinking. WRONG.

If your child is using steroids for alopecia, you may want to DISCUSS THOROUGHLY with your health care provider the possibility of delaying vaccines.

The Merck Manual reads, “Children receiving immunosuppressive agents (CORTICOSTEROIDS, antimetabolites, alkylating compounds, radiation) may have aberrant responses to active immunization procedures. Immunizations for patients on short-term therapy should be deferred until treatment is discontinued. Children on long-term therapy should NOT be given live vaccines but may receive inactivated vaccines such as DTP; > 3-mo AFTER therapy is discontinued, they should be given an additional dose of inactivated vaccine, and then live vaccines may be started.”

Herbal remedies
The following is an exerpt from National Geographic. The article is at the beginning of the magazine, in a section called Geographica. No author mentioned. It is in Vol. 194, number 2, August 1998:

Hair-raising tale of a naked ape

Jambo, a teenage chimpanzee in England's Twycross Zoo, was suffering. His skin itched, his hair fell out, he lost weight, and he seemed listless. Director Molly Badham called in Jean Brown, a farmwife who deals in natural medicines, for help. Mrs. Brown put Jambo on an acid-free diet -- heavy on cereal, yogurt, brown bread, and apricot jam -- and concocted a cream from goat's milk and oils of wild rosemary, parsley, and marjoram. Now his health has returned. So has his hair. And Dr. Brown is trying her diet and salve on humans; her husband is growing hair on a bald spot he's had for the past 45 years.

'I'm not interested in why it works,' she says. 'It works, that's all I care about." She plans to market the product.

Zoo vets believe that Jambo's ailments stemmed from an immune system problem. They are clueless about why the ointment works. 'But he's in full form now,' Badham says."

Melanie Von Zabuesnig (a previous AA patient herself now "recovered") is a herbalist whose work has been published in magazines such as Natural Health. Her email address is vz@earthlink.net her fax number is (714) 956-3115. Here's what she recommends:

Rosemary and Ylang Ylangwill stimulate the scalp, while Lavender and Atlas Cedarwood are balancing oils that help prevent further hair loss.

Massage, gently nightly massages of the scalp will relieve any tightness caused by stress. Make up a healthy Scalp Tonic and apply several drops to the affected area. Massage in such a way that you move the scalp over the bone without pulling, or moving through the hair. Continue for two minutes, on to a different area each 15 seconds.

  • 3 drops Rosemary and Ylang Ylang
  • 2 drops Atlas Cedarwood
  • 1/2 tsp vodka (yes Vodka)
  • 1 fl oz of Orange Flower or Melisssa water

Dissolve the essential oils in vodka, then mix together with Orange Flower or Melissa water. Use for massage as indicated.

Some of our members think that they could not use the vodka as their scalp is very dry and painful, however, the oils can be soothing.

For more information you can contact a licensed naturopathic doctor at the American Association of Naturopathic Physicians, PO Box 20386, Seattle, Wa. 98102, call them at (206)323-7610, or visit the list of CAM practitioners at Natural solutions.

Also a small note on the care of nails in the book "Healing Power of Herbs" by Dr. John Heinerman states the following,

“Thick nails usually indicate poor blood circulation. For this you need horsetail (2 capsule), cayenne (2 capsules) and ginger (2 capsules).

“Lenghtwise ridges sometimes means kidney dysfunction and anemia. For this you would require horsetail (2 capsules), buchu (2 capsules), dandelion (2 capsules) and parsley (2 capsules).”

(See also pepper shampoo and aromatherapy)

Hirsutism
The term referes to the excessive growth of facial and/or body hair in women. It is usually characterized by the growth of coarse terminal hairs on androgen-dependent areas of the body such as the chin, preauricular area, chest, abdomen, and anterior thighs. Principal causes include abnormal regulation of androgen production by the pituitary gland, elevated androgen production by the adrenal glands or ovaries related to the presence of tumors or cysts, decreased levels of carrier proteins, principally sex hormone-binding globulin (SHGB), or intracellular modification and binding to the androgen receptor. Hirsutism is a response of the hair follicles to androgenic stimulation and increased hair growth is often seen in endocrine disorders characterized by hyperandrogenism. In hirsute women, daily testosterone production is increased 3.5-5-fold and most of the androgen is secreted as testosterone. Increased androgens are associated with lower levels of SHBG, which binds less testosterone and increases its free level. Its onset during the teenage years or in the early twenties is usually associated with excess androgen production, anovulatory ovaries and loss of cyclic mensturation (polycystic ovary syndrome). After the age of 25, some cases showing rapid evidence of masculanization (e.g., clitomegaly, deepening of the voice, balding and even changes of body habitus) have been associated to an overactivity of the adrenal gland or to androgen producing tumors of the adrenal gland or ovaries. Once the protective influence of the estrogens has been removes (postmenopause) most women develop some degree of hirsutism. The basic laboratory tests to investigate hirsutism include full blood count, plasma testosterone, plasma cortisol at 9 AM and midnight, 24 hour urinary 17-hydroxy-and ketocorticosteroids, prolactin levels, ovarian scan, X-ray of the pituitary fossa, leutenizing hormone /follicle stimulating hormone levels (LH/FSH). Therapy for many hirsute women includes cosmetic measures for removal of hair such as, bleaching, waxing, shaving, and electrolysis. For some women, however, antiandrogens such as cyproterone acetate are utilized.

I think women with hirsutism usually suffer from a greater social stigmata than those who lose their hair from alopecia areata. Remember that hirsutism causes hair growing in the face, abdomen and/or breast while simultaneously losing the one in your scalp. Two reasons would make me believe that the endocrinologist (or Gynecologist) rather than a Dermatologist is more adept at treating hirsutism. First, the most common cause of hirsutism is due to increased secretion of testosterone and androstenedione from the ovaries. Second, acromegaly (gigantism after puberty) is seen associated in 10 to 15% of cases.

History of Medicine
Patient says, "I have an earache."

2000 B.C.—Here, eat this root.

A.D. 1000:—That root is heathen. Here, say this prayer.

1850—That prayer is superstition. Here, drink this potion.

1940—That potion is snake oil. Here, swallow this pill.

1985—That pill is ineffective. Here, take this antibiotic.

2000—That antibiotic is artificial. Here, eat this root.

HLA
HLA stands for human leukocyte antigen. They are the proteins embedded in cell membranes that determine whether you are compatible to receive a given transplant tissue or organ. Since they are genetically determined monozygotic twins can accept tissues from their co-twins indefinitely while grafts from other people may suffer a dismal fate- if not immunosupressed. Within a family approximately 25% of siblings will be HLA identical. Which means that the probability of finding an HLA identical donor is usually small. The search for similar subjects is undertaken by assays called "tissue typing". These assays use only the white cells from blood. Red blood cells do not express tissue HLAs.

It may be well worth noting that transplant rejection is mediated through a special type of cell called T lymphocytes- that is, the same type of cells that have been incriminated in rejecting the hair follicle in alopecia areata. There is some work to suggest that alopecia areata is related to an increased incidence of these types of proteins (e.g., DR11). Such an association is not meant to define a cause/effect interaction but rather a thought provoking marker for disease susceptibility. Even in those cases where an association between disease and HLA have been positively identified the mechanisms underlying such a correlation remain obscure. In terms of research it is one of those pieces of data that are nice to know but nobody knows what they mean.

HMO
Taken from Frequently Asked Questions About Health Care By David Lubar:

Q. What does HMO stand for?

A. This is actually a variation of the phrase, "Hey, Moe!" Its roots go back to a concept pioneered by Doctor Moe Howard, who discovered that a patient could be made to forget about the pain in his foot if he was poked hard enough in the eyes. Modern practice replaces the physical finger poke with hi-tech equivalents such as voice mail and referral slips, but the result remains the same.

Of related importance,

Q. Well, can I get coverage for my pre-existing conditions?

A. Certainly, as long as they don't require any treatment.

Q. What happens if I want to try alternative forms of medicine?

A. You'll need to find alternative forms of payment.

Horsetail (shavegrass or "scouring brush")
A herb used as a beauty aid. The stem portion of the herb contains silica which is vital to the health of hair and nail. If your hair has split ends or feels rough, herbalists recommend taking 3 capsules each of horsetail and alfalfa (for the calcium). If your nails are brittle and break easily herbalist recommend taking 3 capsule per day of horsetail and appling the liquid extract of the plant to the surface of the nail for some five to seven minutes until dry.
Hot comb alopecia
A technique used to straighten the hair by oiling and then pulling it through a hot comb. It has been implicated as a cause of irreversible alopecia among black women.
Humectant
An additive used with lubricants that attracts and holds water.
Humor
A coping mechanism and a cure for many ailments. Try these little portions from our bumper sticker collection:
  • Your kid may be an honor student, but your still an idiot
  • Impotence......Nature's way of saying, "No hard feelings"
  • He who laughs last, thinks slowest
  • Lottery: A tax on people who are bad at math
  • Out of my mind. Back in five minutes
  • Born free...taxed to death
  • Sometimes I wake up grumpy, other times I let him sleep
  • Work is for people who don't know how to fish
  • I didn't fight my way to the top of the food chain to be a vegetarian
  • I get enough exercise just pushing my luck
  • OK, who stopped payment on my reality check?
  • Real women don't have hot flashes, they have power surges
  • Some people are only alive because its illegal to kill
  • We are born hungry, wet and naked, then things get worse
  • Beauty is in the eye of the beer-holder
  • Ever stop to think and forget to start again?
  • Be nice to your kids, they'll choose your nursing home
  • I don't suffer from insanity, I enjoy every minute of it
  • I took an IQ test and the results were negative
  • Sorry, I don't date outside my species
  • Consciousness: That annoying time between naps

On the other hand some attempts at selling hair regrowth medication almost sound humorous, take for example a press release from Kevis of Beverly Hills. A U.S. patent recently was approved for "sperm shampoo", which is said to restore hair lost because of male pattern baldness. The company says that Sean Connery, who had lost most of his hair, has been using this natural product to grow it back. A recent America Online survey found that one out of four men would trade five years of their life for a full head of hair, the company says. But hirsuteness does not come cheap. The active ingredient is found on the tip of the human sperm and costs more than $30,000 per kilo (2.2 lbs). "Just as sperm penetrates an egg, Kevis penetrates the hair cuticle & follicle," the press realease claims.

Hypertrichosis
Excessive growth of termiinal hair in areas not normally hairy. It is usually associated with the use of certain drugs (e.g., corticosteroids, diazoxide, penicillamine), malignancies, anorexia nervosa, and porphyria.
Hypervitaminosis A
A syndrome caused by excessive consumption of vitamin A in which the principal features include dryness, irritability and pigmentation of skin, slowly progressive thinning of scalp and body hairs, eyebrows, and eyelashes. Othe symptoms include loss of weight, fatigue, anemia, bone pain, and liver and spleen enlargement. Symptoms appear after an individual takes doses in excess of 50,000 units daily over a period of many months. Slow recovery begins when the use of vitamin A is discontinued.
Hypothyroidism
Hair loss, including the eyebrows, can be one symptom of an underactive thyroid - others include drooping/swollen eyes, yellow-orange skin, yellow bumps on eyelids, fatigue, etc. The most common and/or frequent symptom is being cold while everyone else around you is hot.

You can test yourself INITIALLY for this condition by doing the follow: Put a thermometer by your bed, and when you wake up in the morning, put it in your armpit and keep it there for 15 minutes. Be still and quiet; motion can upset the reading. If it's 97.6 degrees or lower, it may indicate hypothyroidism. Keep a log.

A report by Puavilai S et al. Int J Derm 33(9):632-3,1994) showed no statistical significant differences in the prevalence of thyroid conditions when examining 152 patients with AA and an equal number of age-matched controls.--For some reason my experience is contrary to those of the quoted authors and I have seen many AA patients with thyroid problems.

I

Immunizations
See Hepatitis B and Vaccinations.
Immunoglobulins
Antibodies produced by the lymphatic cells to combat infections or other invading substances.
Immunological priviledge site hypothesis
I have had 15-20 patients tell me that their active phase to AT or AU was precipitated by severe dandruff. My girl, Belinda is one of them. It seemed that she had almost to much hair when she was born. I think that the overabundance of hair and dry skin procreated the scenario for dandruff to develop.

Some of the patients tell me that they had so much dandruff that in order to make it less noticeable they picked the scabs with their fingernails. One of the patients from our list server, had his attack precipitated by removing a cyst from the scalp. The immunological priviledge site hypothesis envisions a possible hair-follicle barrier (similar to a blood-brain barrier) that could be disturbed (by trauma, infection, etc.) thus exposing an antigen to the inflammatory cells of the blood.

A virus could act two ways. First by disruping this barrier and exposing the antigen from its priviledge site. Second, by lowering the number of suppresor cells thus providing for a flare-up of the autoimmune reaction. Stress may act similarly by altering the CD4/CD8 ratio of lymphocytes. This way of thinking is interested in finding out whether the hair follicle is considered an immunological protected site (e.g., if the vessel wall of the capilaries of the papilla don't have fenestrations, tight parenchymal space overlying the capillaries preventing diffusion, unusual periadventitial cells, etc.).

Indian medicine (Ayurveda)
Ayurveda refers to India's traditional system of medicine. This type of alternative medicine was popularized in the US by Dr. Deepak Chopra an endocrinologist and former chief of staff at the New England Memorial Hospital. His influence stems from Mabarisbi Mahesh Yogi who is better known as the founder of transendental meditation and for having been at one time the guru for the Beatles. Dr. Chopra was impressed by the ability of some ayurvedic practitioners of obtaining a lot of information on a patient (physical and emotional) just by taking their pulse. He popularized his thoughts through best selling books such as Perfect Health.

Ayuv-vedic practice looks at the whole person and determines through questionnaires and exam a certain psychophysiological constitution based on physical characteristics; food, sleep and climate preferences; cognitive style, etc. There's a good book by Dr. Vinsent Lad about Ayur-vedic medicine. The idea is that illnesses develop as a result of imbalances in the constitution(s) -- you can be one, or a combo of 2 or 3 types. Through diet, daily practices (e.g., regular sleep hours) or whatever is appropriate for balancing your dosha (constitution), you become balanced. In addition to those, sometimes certain supplements and/or herbs are called for either for general health or to address a specific problem.

On a personal note, Dr. Chopra is extremely wealthy, a fact that is due to revenues from his books but also from his large and ever growing number of patients (followers). He has sold the idea of "rejuvenation" through herbal oil, heat therapies and "purification" treatments. I consider that his fees are somewhat outrageous (several thousand dollars) for a week's treatment and he even charges for mail consultation. I developed a personal interest in this type of alternative medicine and must say that my daughter is receiving treatment from a more traditional ayurvedic practitioner in India (for free). Right now, after about a year of treatment, I haven't found any positive effects from the therapy. I have also asked several patients that have pursued this type of alternative medicine and they have all basically told me the same thing; interesting, lots of history involved, didn't work for me, but there were no side-effects.

If you are interested in trying this alternative, there is an Indian oil readily available for this purpose. The Bringraj Oil can be ordered through Bazaar of India Imports, 1810 University Ave, Berkley, California 94703, phone: 1-800-261-7662. The price for an 8 oz. bottle (which lasts a long time) is under $20.00. It is applied to the scalp 4-5 times a week at bedtime and washed out in the morning. The Bringraj oil does not irritate the scalp. Its ingredients are listed as: Natural Sesame seed oil, Ayuverdic Eclipta alba, Sida cordifolia, Withania somnifera, Natural fragrance.

My only personal positive experience regarding traditional Indian cures relates to shampoos. Both my daughter and wife have a very senstive skin. Normal shampoos irritated the skin of the scalp unprotected by hair eventually causing a lot of itching. I discovered a herbal powder in an Indian/Pakistani store that does an excellent job without causing irritation. It is a mixture of soapnuts (aritha), acacia concinna (shikakai), emblica (amla), eclipta (bhangra), cyperus seariousus, turpeth root, eleusine corocana, and nardostashya. I hope that I have spelled everything correctly.

Ayurveda is different from Hindu philosophy. Most Hindu teachings emphasize relinquishment and renouncement. As applied to alopecia, this way of thinking directs you to relinquish your attachment to hair and any idea of control over it, while still valuing hair for it's beauty and purpose. You must renounce all personal claim and stake you may have to the resulting appearance or disappearance of hair. In this is freedom.

Informed consent
A legal term pertaining to the disclosure of sufficient information by a physician to enable voluntary participation by a legally competent patient. The informed consentusually provides for the following:

A statement that the study involves research, the reason why the person signing the informed consent will participate, description of the benefits and foreseeable risks to the patient (e.g., cancer for those taking sensitizers), a disclosure of appropriate alternative procedures or treatments, a description of the confidentiality of records, an explanation whether compensation or medical treatment is available if injury occurs and, if so, what they consist of, an explanation of where further information may be obtained about the study itself and the research subject's rights.

After the recruiting physician provides the information on the study, see if you can answer the following questions:

  • What is the reason for the study?
  • If you want to, could you quit the study? (at any time)
  • How long will the study last?
  • Is there a placebo (something like a sugar pill) component to the study?
  • Can you list some of the mild/serious side effects to the medication?
  • If you are a woman, have you been asked to use an acceptable method for birth control?
  • Are there unforeseeable effects of the medication on yourself, or in the fetus?
  • Is it possible that the symptoms might worse while you are in the study?
  • Can you describe the tests, or assessments that are going to be performed as part of the study?
  • If you have any questions regarding the study, who can you call?
  • Will this program cost you money?
  • How much money will you receive for travel expenses?
  • After you have finished the tratment, then what happens? (Are there any follow-up studies, will the drug be offered to you free of charge?)

Be sure to clarify any doubts before consenting to participate in any clinical study.

Interleukin
A family of hormonal-like polypeptides produced in reponse to trauma, infection, and other inflammatory states. Some of these factors have been implicated in evoking and maintaining the inflammation at the base of the hair follicle in patients with alopecia areata.
Interstitial Cystitis
IC is an autoimmune condition (sound familiar?). There's an impairment of the gag (lining) layer of the bladder, leaving parts of the bladder wall unprotected. Symptoms can include frequency, suprapubic pressure (e.g. a feeling of several telephone books pressing on the abdomen), feeling every drop of urine as a battery acid type burn on the unprotected bladder wall, urethral burning pain. Any or all of the symptoms are the hallmark of the disease alone with *sterile* urine (meaning no bacteria). IC can be diagnosed by the preceeding symptoms and/or by bladder biopsy (revealing mast cell activity) of the bladder under general anesthesia. In this anesthesized state, the patient's bladder is filled several times with water to measure bladder capacity; generally a hemorraghic bleeding will be observed.

The most effective treatment I have seen for IC is a yeast free diet (for at least 6 months) and treatment with an oral fungicide such as Diflucan.

Intravenous immunoglobulins (IVIgG)
Autoimmune conditons are a result of a dysregulation of the immune system. It is postulated that altered expression and function of T cells leads to the production of autoantibodies. The use of intravenous immunoglobulins (IVIgG) has shown promising results in controlling some of these condtions (e.g., multiple sclerosis, Guillain-Barre syndrome, etc.). IVIgG is an FDA approved preparation (since 1982). Its mode of action was reviewed by Dwyer, 1992 who proposed among other things that IVIgG inhibited T cell cytokine generation and function. In a recent report by Ostlere et al. (Br J Derm 131(5):735-6, 1994), a case report of a single patient showed that after treatment for 8 months there was significant hair regrowth which was maintained even after 2 years of follow-up. This is interesting because a previous report indicated hair loss as a side effect of the use of IVIgG. The authors suggest that the preparation of IVIgG may bear on the outcome. Ostelere's conclusions receive some backing (although he never quoted anybody) from another study by Skvaril et al: Differences among available immunoglobulin preparations for intravenous use, 1988.

IVIgG side effects include headache, nausea, emesis, chills, fever, abdominal pain, muscle pain and fatigue. Many of these effects appear to ber elated to the infusion rate. Risks related to transmission of infectious agents or hepatitis have been excluded by screening laboratories.

This is another story (unfortunately a long one) but when I started trying to help my daughter I came to the conclusion that any discovery should be based on the good will of other people and that a cure should be offered gratuitously. It is part of the third stage of Hindu philosophy where a person has to return to the world some of the blessings that have been bestowed upon him. The idea of using IVIgG in alopecia areata appeals to me, not only on its scientific basis, but because the availability of the product (a human compound) depends on the good will of those that are healthy (a blood donation). In a certain way, I envision this as the strong helping the weak.

Iron
The hair is sensitive to states of iron deficiency. It is one of the first structures to disappear in order to preserve the iron supply for other more essential purposes. Hair loss in these cases tends to be diffuse and accompanied by a lightening of its color (e.g., black hair turning brown). It is important, especially women, to correct for any iron deficiency before initiating any therapy (e.g., minoxidil for androgenetic alopecia).
Iron deficiency
Iron deficiency is common in both children and adults throughout the world. However, iron deficiency in childhood differs in many ways from that in adults. In children the most likely cause is an inadequate amount of iron in the diet, coupled with the extra requirement for iron because of growth. In children, the non-anemic effects, such as behavioral change, cognitive and psychomotor deficits, and decreased immune function, are more likely to be clinically apparent. For example, lack of iron may affect cognitive and psychomotor development during vulnerable periods such as the toddler years. Quite significant degrees of impairment have been found. It is difficult to predict how much impairment an individual child with a given degree of iron deficiency might suffer, but it seems unlikely that major effects occur in the absence of anemia. Behavioral changes such as lethargy, irritability, and inability to concentrate may also occur.

In adults, iron deficiency occurs in several stages. In stage one, iron stores are reduced but there are no clinical effects. In stage two, there is a biochemical deficiency without anemia, which results in adverse consequences on aerobic work performance, immune function, and psychomotor development. The third stage is the most severe because no iron is left in the marrow and hemoglobin production falls below the reference range. Iron deficiency should be considered in the diagnosis of patients who present blood loss, anemia, symptoms such as lethargy, dizziness, and high-risk lifestyle or dietary factors.

Irritants
Irritants to treat AA have been around for a couple of thousand years or so. Mustard seed poultice, burnt papyrus rubbed into the scalp etc. so irritants are nothing new. The popular belief is that irritants work as antigenic competition. That is, the irritant chemical applied to the scalp is far more interesting to the inflammatory cells than the hair follicles. Thus the cells move away from the hair follicles and towards the skin surface where the irritation is. It would seem the cells find the irritating chemical much more of a threat and something to defend against than the hair follicle antigens.

However, I am not convinced of this idea. It assumes that the cells responding to the irritant are the same as the cells responding to the hair follicle antigens. I don't think so. I think the irritant induces inflammation from a mostly new group of cells and in doing so causes a change in the cyotkine environment of the skin. Cytokines are hormone like chemicals that are produced by inflammatory cells to communicate with each other. Some cytokines excite immune cells to attack and destroy, other cytokines tell cells to calm down and go home. I think there might be a change in the cytokine response that encoruages cells to move away from the hair follicles and into the upper skin layers and/or to leave the skin entirely. There is some research to suggest irritants cause cytokine production levels to change.

Isoprinosine
A chemical that potentitates the action of T lymphocytes and phagocytes. Some trials have reported regrowth of hair in patients with alopecia areata when using this medication. Side effects of isoprinosine include nausea, headache, drowsiness, dry skin, and a mild increase in serum uric acid.

K

Keratosis pilaris

“My 13-year old has had AA since 2/99. In addition to the AA, she has some interesting skin conditions which I am wondering are somehow related to the AA. Since 10/98, she has had red bumps all over both legs, mostly on her lower legs. I just noticed today how bad this has gotten. She says the red bumps are not itchy or painful. She won't wear any shorts, because she is so self conscious. This condition first started when she had swimming in her PE class, and there was lots of chlorine in the pool. Allergic reaction to chlorine, even after 8 months has gone by??”

It sounds like your daughter has keratosis pilaris. The bumps may also be on her buttocks, back of her arms or even the back. They are associated with eczema, which is associated with AA. There is no cure but treatments include brushing the area with a lufa sponge or a Buf-Puf followed by a moisturizer, ammonium lactate, tretinoin or adapalene.

Keratinocyte
The superficial(top) cells of the skin. Some researchers have proposed that in alopecia areata a defect in these cells propitiates the release of chemicals (interleukins- see definition) the end result of which is an inflammatory reaction at the base of the hair follicle.
Kinesiology
Kinesiology is a painless alternative 'medicine' which uses a combination of the energy pathways within the body (the same ones used within acupuncture) and muscle resistence to identify whether you are allergic to a substance. In practice I don't think this approach can diagnose the cause of a problem, i.e. alopecia, but practitioners claim that it may identify bottlenecks within these energy pathways.

During a session the kinesiologist may have a patient lay on his back with the mid-drift exposed. The practitioner then helds various substances close to the patient's belly button (where a lot of his energy pathways congregate) while holding up his arm and trying to push against the kinesiologist's hand in order to detect muscle resistance. A positive test is claimed to help identify intolerances to substances as well as full blown allergies.

Kombucha
The manchurian tea mushroom, also known as Kombucha is in reality a colony of yeast and bacteria rather than a mushroom. It is used as an ancient tonic that reputedly soothes the scalp, helps stop balding and eliminates gray hair. Some herbalists claim it is the panacea of all ailments, including AIDS. The "mushroom" and its medicinal properties have been around for many decades but the only positive claims that I know of come from herbalists. There are several books on the subject of which one is worth reading, "Kombucha Manchurian Tea Mushroom: The Essential Guide" by Christopher Hobbs, published by Botanica Press.

L

Langerhans cell
The dendritic cell that resides in the outer layer of the skin(epidermis) and play a role in immunosurveillance against virus and tumors. Langerhans cells take up, process, and then present antigents to T lymphocytes. Ultraviolet radiation damages Langerhans cells.
Lanugo
Fine long hairs covering the fetus. It usually disappears one month after birth. Its reappearance during adult life has sometimes been associated with malignancies. It is soft, fine and usually unpigmented.
Lead
One of the elements within our chemical environment that has promoted ourbreaks of poisonings. In children it is aquired as pica (the abnormal ingestion of peeling lead-base paint) and in adults by those who work with lead-soldered kettles and lead-glazed pottery. Some of the usual manifestations of lead posoning include anemia,memory lapses, irritability, nerve palsies, and kidney problems. An interesting story relating to alopecia was related during a documentary about the building of the Golden Gate Bridge in San Francisco Bay during the 1930's. According to the narrator, a "funny" thing happened -- some of the workers lost their hair! The individual in the documentary who talked about it was Stephen Cassady, author of "Spanning the Gate." Here's what was discussed:

The men who worked on the construction of the towers for the bridge started coming down sick with unexplained ailments. Their hair was falling out; they had nausea, and at one point in time 60 men were in the infirmary diagnosed with appendicitis.

The cause was determined to be red lead paint that was used to coat the steel to protect it from the elements during its transportation from Bethlehem Steel in Pennsylvania to California. The holes for the rivets in the steel were covered with a thin membrane of the paint, and when the riveters started assembling the steel cells together the fumes from the paint caused their illnesses and hair loss.

To correct the situation, fresh air was pumped down inside the towers where the men were working and they were given filtration masks to wear. Most refused to wear the masks though.

Lichenification
Lichenification occurs on skin surfaces as the result of repeated rubbing and scratching. Morphologic features of lichenification include: palpable thickness of the skin compared to nearby normal skin; accentuation of the normal cross-hatched skin markings; and, the presence of lichen-type scale. It may occur secondary to many pruritic dermatoses or develop as a localized abnormality without any predisposing diseases. Common diseases predisposing to secondary lichenification are atopic dermatitis, nummular eczema, pruritus ani, lichen planus, and asteatotic eczema.
Lichen planus
A disease of presumed autoimmune origin occasionally associated to alopecia areata. It produces a flat-top violaceous eruption sometimes associated with scaling. Similar to psoriasis the papules may occasionaly be arranged in a linear configuration. Although the eruption may be seen throughout the body, but it has a special predilection for the writs, penis and mouth. Lichen planus is extremely itching. On a few cases the nail changes attributed to alopecia areata were later proven to be due to lichen planus.
Lichen simplex
Localized lichenification due to rubbing and scratching of skin previously apparently normal, i.e. primary lichenification. Physical signs of primary lichenification are the same as in secondary lichenificaion. It usually occurs between the ages of 30 and 50. In lichen simplex, only a few lesions are present, and in fifty percent of the cases only one lesion occurs. The areas most commonly affected are the nape of the neck, the shin and the calves, the upper thigh, the extensor surface of the forearms and various sites on the external genitalia. For lichen simplex, the patient should be given an understanding of the need to break the scratching habit. Treatment includes topical steroid creams and intralesional triamcinolone.
Liquid nitrogen
Liquid nitrogen was the fad of the late 80's and early 90's. The intial application of a spray was replaced by the cotton swab. One of these studies reported hair growth in 70 out of 72 patients. That is a 97.3% success rate. Hair regrowth was often seen after just a couple of treatments. I imagine that the fad died because it was primarily used in academic centers.

Although the side effects of this treatment were surprisingly few (swelling, itching, etc.) I have some concerns regarding future outcome. In my own experience freeze/thawing cycles reduce the total number of generations or passages of fibroblasts in cultures. These were the cells I had isolated from skin biopsies in my AA patients. The reason I was studying fibroblasts is that they are found at the base of the hair follicle and ultrastructural studies suggest that they are abnormal in patients with alopecia areata.

Anyway, there is some evidence from the medical literature to suggest that freeze/thawing promotes an oxidative injury to cells. If this cells are already compromised by the inflammatory response at the base of the hair follicle, why injure them again?

Locks of Love
Peggy Knight is the founder of a non-profit organization called Locks of Love. Its mission is to provide wigs to children who are suffering from alopecia. Each year, several children receive a vacuum or suction wig with human hair at no cost. The organization has grown rapidly. It now has a new board of directors and executive director. The mailing address is Locks of Love,1640 S. Congress Ave., # 104, Palm Springs FL 33461. The phone number is 561-963--1677 and the FAX is 561-963-9914. Your contact person is the executive director Jennifer Hornsby. Jennifer has an all volunteer staff and they have moved into the new donated office.
Loose anagen hair syndrome
In this condition hair is lost because it is poorly anchored to the scalp. It is seen primarily in girls 2 to 9 years of age. Light hair color is a common feature. Other features include the presence of dry, lusterless hair which can be easily and painlessly removed with a gentle pull. Extracted hairs may be missing either the outer root sheath, the inner root sheath, or both sheaths. The disorder usually improves with aging and may be transmitted as an autosomal dominant condition.
Love
Love is best explained by actions, as when one of our participants was trying a nasty chemical treatment on her scalp and her whole head blew up like a balloon. Her kindergarten daughter said, "you look so pretty mommy, you should go on a date".
Lymphocytes
A type of cell found in the blood essential for fighting infection and important in providing immunity.

M

Madarosis
The term means loss of eyelashes. It can be caused by infections, plucking of hairs, trauma, or systemic diseases such as aloepcia areata. Lash transplantation is not considered an option because of the relative high incidence of lossing the transplanted hairs. Some people opt for blepharopigmentation which is the tattooing of pigment into the eyelids. Blepharopigmentation is used only occasionally since there are difficulties in removing the pigment in cases with unsatisfactory results.
Male escutcheon
The upper triangle of pubic hair that grows towards the umbilicus. It grows under the influence of testosterone which explains why it is found in males and usually absent in females. The lower triangle of pubic hair is under the control of both adrrenal and testicular androgens.
Malnutrition
A condition caused by inadequate intake or inadequate digestion of nutrients. It may result from eating an unbalanced diet, digestive problems, or absorption problems. Malnutrition is a general term that indicates a lack of some or all, nutritional elements. Often times, malnutrition is a result of a deficiency in the diet. Malnutrition can also occur when nutrients are adequately consumed in the diet, but one or more nutrients are not digested or absorbed properly. Symptoms vary with the specific malnutrition-related disorder. Treatment usually consists of replacing the missing nutrients.
MAO
I don't believe that MAO inhibitors would be of use in alopecia areata. Their side-effects may even pose some serious health problems. Selective inhibitors may have a safer profile but also a restricted region of action (e.g., lazabemide in the brain). I would like to venture a guess that any benefit these inhibitors may have is not mediated through a catecholamine imbalance. My main experience has been with selective MAO-B inhibitors. MAO-B enzymes are involved in the deamination of dopamine and trace amines including phenylethylamine. During the deamination reaction catalyzed by MAO-B, hydrogen peroxide and hence hydroxyl radicals are formed, therefore, excessive activity of MAO-B is likely to contribute to oxidative stress. The accumulation of free radicals leads to lipid peroxidation and cell damage. You can probably postulate that due to the inflammatory infiltrate at the base of the hair follicle, oxidative stress may play a role in alopecia areata. However, I am not sure that MAO activity has been measured in the scalp biopsies of patients with AA or even peripherally within their platelets. If MAO inhibitors were to work this way in alopecia areata there would be safer alternatives available.
Melanin
The skin and hair bulb pigment produced by melanocytes. Black and brown hair have eumelanin, while red and blond hair have phaeomelanin. In aging the amount of pigment diminishes causing greying (canities).
Melanocyte
The cell in the skin responsible for pigmentation. Scalp biopsies of patients with alopecia areata have shown morphological abnormalities in these cells including their enlargement, roundness (they are usually ellipsoid), and disrupted pigmentation.

Melanocytes are sensitive things, easy to disrupt or destroy, e.g., a little dry ice briefly applied to hair bearing skin will not do any permanent damage to the skin but the melanocytes in hair follicles are mostly destroyed resulting in poorly pigmented hair. Skin melanocytes will repopulate quickly from unaffected neighbouring areas but hair melanocytes do not recover well. Very occasionally in AA the melanocytes are not switched off and continue to produce melanin. With no hair fiber to incorporate it into, the melanin gets dumped at the bottom of the hair follicle giving the skin a bluish hue.

Melatonin
A hormone produced by the pineal gland. In amphibians, melatonin produces marked lightening of the skin but its role in humans is still debated. It is produced at a rate inversely related to environmental lightening. Melatonin has been recommended for people having trouble falling asleep due to a resetting of their circadian rhythm. Increasing dosages are necessary with aging since the pineal gland seems to wear out and produce less of the hormone. The hormone itself has a very short half life (40 minutes) which presents a challenge for those needing some type of replacement therapy or if insomnia occurs in the second half of the night. The physiologic range of melatonin can be approximated by doses in the 0.2 to 0.5 mg range. Doses above 1 mg are considered to be pharmacologic (i.e., potentially having effects outside of melatonin's natural role). Dosages over 10 mg are not cleared over night and may produce daytime drowsiness. Two books well worth reading for those requirig more information are "Melatonin" by Russel J. Reiter and "The Melatonin Miracle" by Walter Pierpaoli and William Regelson. (See also Echinacea)
Mercury
A metallic compound capable of producing diffuse alopecia. Usually the organic forms of the metal (e.g., methylmercury) are more dangerous because of their better absorption and slower elimination. Organic mercurial compounds can be synthesized by bacteria found in the soil and bottom sediment of water sources. Exposure is usually related to contaminated fish (industrial pollution) and ingesting byproducts of grains treated with methylmercury fungicide. Inorganic mercury is found in some dental amalgams. Besides alopecia other symptoms of mercury intoxication include sensory impairment, constriction of visual fields, lack of coordination and speech disturbances.
Merkin
False hair (a wig) for the female pudenda. Now, the real question is what acts as the Velcro attachment? These days with body piercing being the rage, is it pinned on? Aaaaarrrrrgh!! OR, who fits the wig in place? Are there floor samples to try on? Are there natural wigs, and where do they come from? Answer: The bathroom floor. Next time I go to my wig guy I will have to ask him (NOT)!! I knew a guy once that lost his thumb in a work related accident and the doctors took his big toe and sewed it into his hand in place of it. Now, if they could do some similar replacement for alopecia totalis, would it constitute wearing a merkin on your head. Well that is OK, after several years some husbands can't differentiate a merkin from false bangs.

My southern friends always make me smile when saying "American" around me (A-MERKIN is the Texas and Georgia pronuciation). For word lovers, merkin is also the mop used for swabbing cannons (makes you wonder, doesn't it?). Although a sporran is the term used for those furry pouches that Scottish bagpipers usually wear in front of their kilt, maybe it should also be called a merkin. Just when I had finally gotten over thinking about the fact that they don't wear "underware"! Some females may actually never want to get over this fact (do you think they like bagpipes just for the music?). Still, no, it wasn't a typo, ware means manufactured articles or products of art or crafts. So in a certain sense, I think that underware is better than underwear.

“A dirty mind is a joy forever.” —Socrates

Minoxidil
A pharmaceutical agent originally used as an antihypertensive medication. It is now used topically for male pattern baldness. It has proven of some use in alopecia areata for patients with mild/moderate involvement of their scalp. Some people experience an increase in hair shedding which is rapidly followed by regrowth when using minoxidil chronically. Minoxidil takes at least some 4 months of chronic usage before its efficacy can be determined. Hair growth is not permanent and will revert after cessation of treatment. Adequate data is not available to judge the effectiveness or safety of this drug in children.

Irritation and dryness of the scalp are 2 of the most common side effects of Rogaine. Some people say it is due to the alcohol (ethanol) content of the medication (78%). Some patients have told me that washing their hair and leaving it slightly wet (to dry naturally) before aplying the medication may alleviate the dryness. Applying an emollient may be another good idea, as it should not interfere with the absorption of minoxidil. Sometimes corticosteroids in an oily media may have beneficial effects. They act as an emollient and also as an anti-inflammatory agent. Skin biopsies in some cases of androgenetic alopecia have shown an occasional mild inflammatory reaction. This has given rise to a few trials using Rogaine in combination with corticosteroids.

Several stories from our partcipants bear repeating.

Case story one

“I have been using Rogaine as recommended by my dermatologist for a little over a month now. At first, my scalp was very tender, but that seems to have gone away. I don't see any regrowth yet, but I suppose it's too soon. The problem is...today I noticed for the first time that I've developed dandruff! I know that, in the big scheme of things, this isn't very important, but it's annoying and a little embarrassing. I've never had dandruff before and think it may be due to the drying effects of the high alcohol content in the Rogaine.”

Case story two

“Yesterday was my 24th birthday, and I was celebrating with my mother and her husband. They had bought a beautiful cake and had brought it over to my house. Well, the candles were placed on it and lit. I made a wish, leaned over to blow the candles out, and MY HAIR CAUGHT ON FIRE!!! I heard a whooooshing noise and saw the flame in my peripheral vision and reflexively jerked my head back. I guess the "wind" from my sudden movement put the fire out. Of course, I immediately started wailing, "My hair! My hair!" Meanwhile, my mother was frantically saying, "Are you okay? Are you burned?" I didn't even bother answering her questions, but just kept saying, "My hair! My hair!" as I surveyed the damage.

“My mom and I went out to the garage and brushed out the charred mess. I kept seeing clumps of hair, two or three inches long, fall to the floor. My mother just kept telling me how lucky I was to not have been burned. Of course, I had no appreciation for this obvious fact, and was mourning the hair that had burned.

“After carefully checking out the damage today, I can laugh about the whole thing, because I don't think it's noticeable. The ultimate irony is that, I think the high alcohol content of the Rogaine I've been using (it's 60% alcohol) is probably what caused my hair to catch on fire so readily. So, in my case, any success I might have with Rogaine in terms of hair regrowth is most likely going to be overshadowed by this incident!

“So, I guess the moral of this story is that you should be extra careful around open flames when you've been dumping high alcohol content preparations on your hair twice a day, every day, for months!”

Case story three

“The two dermatologist-recommended treatments I have tried in the past that have caused the biggest physical problems for me (short-term/long-term) were Rogaine and steroids.

“Specifically, the Rogaine caused me to have nausea, dizziness and a scalp rash where I applied it topically. The derm had me on Rogaine Extra-Strength for Men (not FDA approved for use in women and of questionable value for AA conditions, BTW). The derm claimed the Rogaine could not be causing these side effects even though Rogaine's own web site claimed otherwise. Funniest thing, minute I took myself off the Rogaine the problems stopped.”

Case story four

“Our dermatologist recommended Rogaine for our son when he was three (now 10) - we used it about 6 months and had lots of regrowth, but Zach was just destined to be AT. No side effects, unless you count facial hair on a three year old.”

(Note: The box for Rogaine says not for use in children.)

Case story five

“Rogaine side effects include hypotension (lowered blood pressure), dizziness, from lowered blood pressure. Rogaine was initially a blood pressure medication found out to cause men with male pattern baldness to grow hair. This was a side effect. Then it was found out to grow hair better than to treat people with high blood pressure, hence the marketing of the medication for hair growth. While it did not do that greaty of a job ffor people with high blood pressure, it can lower blood pressure in people with normal blood pressure. My son who six, was put on rogaine 5%. I only used it for a few days when we quit. I was cautioned by our derm at the time that it may cause him to become dizzy or pass out but that the instances were rare. I really don't know how he could give me these facts because the medication has never been tested or reccomended for children. If these are the side effects for adults, imagine what they could be for children, especially if you are applying it to the scalp, the most vascularized area on the body. I don't care what anyone says. Things applied to the skin are absorbed systemicaly. This I found out when given topical steroids to use and my son became very emotionaly labile, angry one minute to tears the next. This resolved when we quit using the steroids. Better healthy and happy without hair than with.”

One has to be careful, as some people confuse irritation with dryness. There have been only a few case reports of contact dermatitis, but most of the complaints have really been "contact irritation". The probable culprit for the irritation is propylene glycol. Rogaine is 20% propylene glycol. Upjohn limited the concentration to 20% because anything over 25% would cause an irritation on anybody. This compounds acts as an oily media to deliver the minoxidil (which usually constitues only 2% of the medication) to the scalp. Contrary to ethanol which evaporates quickly, propylene glycol may linger for a while or it may even build up a residue. This is why it is important to wash your hair freqently while using Rogaine.

Ethanol has a low flash point and could easily spark a fire, but I do not believe it stays behind all that long before evaporating. Propylene glycol does not have a low flash point, but as I said, it could possibly build residues in the scalp.

As of January 1998, Rogaine (minoxidil) will be available over-the-counter. According to some Dermatologists the 5% solution will grow up to 45% more hair than the 2% solution with the onset of hair regrowth ocurring at eight weeks compared to the current strength Rogaine which begins regrowth at 16 weeks. The new strength Rogaine is not recommended for women bcause it causes more facial hair Just what some people need, huh? Guess that a beard on a woman will take the focus off the lack of hair on their head!

Let me try and summarize some of what I have recently learned (in 1998):

Under the best of circumstances it is very difficult to quantitate hair. The methods are tedious, cumbersome and easily influenced by the style, length and coloring of the hair. Furthermore you have to account for a placebo effetc. Patients want to get better and under any therapy some of them are going to report some amount of improvement. This is equally the case for physicians who want to see improvement in their patients even when they are taking placebo. Many times hair counts do not correlate with clinical response to treatment.

The initial minoxidil (Rogaine) data submitted to the FDA on androgenetic alopecia is interesting. At four months minoxidil caused hair count increases in both the patient and the PLACEBO group! There was another evaluation at 12 months but by then all of the patients had been shifted to the active chemical. This means that at 12 months there was no placebo group to make a comparison or serve as a reference. The study did not offer any long term results but several other authors (Olsen et al, Koperski et al) have published their findings. The results suggest that hair regrowth peaks at 12 months and then declines. Overall the data for minoxidil in androgenetic alopecia is difficult to interpret and, if positive, only offers for some modest and temporary improvement.

The results for the use of Rogaine in alopecia areata are even less satisfactory. Most of the trials offering any improvement were done using it in combination with steroids. Thus far, the FDA has not approved the use of the compound for alopecia areata.

Minoxidil recently went over the counter and can be obtained without prescription. When generic versions were offered at Walmart's for $7 a bottle there was a need for the Rogaine people to establish a new need for their product. Out comes new and improved 5% Rogaine! Incidentally, in the history of pharmaceuticals it is very rare for a drug to go directly over the counter (no prescription)- just as Rogaine did.

As noted above some Dermatologists and the promoting pharmaceutical company claim that the new and improved 5% Rogaine grows 45% more hair than the 2% solution, with regrowth as early as two months and overall 5 times more hair regrowth than placebo. This is interesting since, as you may remember, in the previous trial with the 2% solution the placebo group actually grew hair. Thus far I haven't been able to substantitate these claims with a number of independently published studies. Those persons advocating the use of 5% Rogaine in androgentic alopecia and quoting the newly discovered beneficial effects are accepting as facts whatever the pharmaceutical industry have told them.

There is no experience with the 5% Rogaine in alopecia areata, but if we can extrapolate from the previous experience with the 2% solution, there shouldn't be any benefits. Forcing hair to regrow while on the active phase of the condition may be similar to kindling a fire. There is no assurance that the new hair will be lacking the antigen that incited the original autoimmune reaction. Also, it doesn't make that much sense to use a vasodilator (Rogaine) during the active phase of the condition. The end result of increasing blood flow may be to bring more inflammatory cells to the area and promote the autoimmune reaction rather than curtail the same.

Misinformation
A recent (May 9, 1996) definition for alopecia areata in the Electronic Textbook of Dermatology: “alopecia areata probably belongs among the manifestations of neurosis, and psychiatry occasionally can give rapid and instructive cures.” Neurosis per se is no longer an accepted term in psychiatry. Probably the terminology goes back to the same time period when the word physician was synonymous for leech.
Mites
(See also Demodex and eczema.) The house dust mite's name is "dermatophagoides pteronyssinus". They belong to the sarcoptiform genus (like scabies). There is even one named "d. scheremetewskyi" that attacks man and causes mange-like inflammation. People may be allergic to them and have as a the most common manifestation to them allergic rhinitis; HOWEVER, the little buggers also trigger bronchial asthma, food allergies, and ECZEMA (aka atopic dermatitis, allergic dermatitis).

The immune response to them appears to come in two "forms". For eczema (including *infantile* dermatitis), it looks like the first response is an allergen-specific T-lymphocyte proliferation related to the development of allergic cellular inflammation, in other words the T-cells show up because an allergic reaction to house dust mites (HDM) is happening. Some research hints to a HDM protein called "farinae" as the most positive allergen. Farinae is believed to be the mite's defense system against bacteria. A later human immune response is HDM-specific IgE antibodies.

In contrast, for bronchial asthma (BA), researchers found that IgE-mediated allergic reaction occurs first, and allergen-specific T-lymphocytes do not become significantly elevated until starting at the age of about *8 years*.

Some people have suggested that people who become hypersensitized to dust mites and have eczema, bronchial asthma or food allergies as a result, may also become hypersensitized to the hair follicle demodex mite resulting in rosacea or alopecia.

Myasthenia gravis
A disease of the nervous system caused by autoimmune disease. Symptoms include muscle weakness and easy fatigability. There have been several recent reports relating maysthenia and alopecia areata, the abstract of one of them is as follows:

Of 202 patients with myasthenia gravis (MG), 6 (3%) developed alopecia areata. All six patients had a thymoma cerified by pathology; the frequency of alopecia areata rose to 17% of 35 MG patients with thymoma. In one patient who had no recognizable tumor in the mediastinum, an ectopic thymoma was present in the anterior neck. Kubota et al. Myasthenia gravis and alopecia areata. —Neurology 48(3):774-775, 1997.

There is a similar article by Kamada et al. Alopecia areata associated with myasthenia gravis and thymoma: a case of alopecia with marked improvement following thymectomy and high level prednisolone administration. Journal of Dermatology 24(12):769-772, 1997.

N

Nail buffing
Polishing the nails by using abrasives and a chamois-covered buffer. The resultant shiny nails provides an alternative to wearing nail enamels.
Nail enamel/base coat/top coat
The nail enamel, also known as laquer, varnish or nail polish, colors and provides gloss to the nail plate. The base coat is colorless and is applied before the nail enamel in order to clean the nail surface. The top coat is used over the enamel to provide gloss, prevent chipping and prolong wearing time. The application of base coat, enamel and top coat help trap moisture and may be helpful in patients with dry, brittle nails.
Nail hardener
A slightly modified nail enamel to which hydrolized proteins or acrylate resins are added. The polymeric chemical compound is used to strengthen fragile/flexible nails. Those nail hardeners that contain formaldehyde may cause contact dermatitis or even hemorrhagic reactions of the lips among nail biters.
Nail moisturizer
Nails contain approximately 16% water. Moisturizers return water to nails that have become dry, brittle or fissured. In order to obtain maximum benefit from the moisturizer, nails have to be soaked in lukewarm water for 15 to 20 minutes. The moisturizer is then applied and the hand covered with a glove or sock to form an occlusive dressing. Moisturizers may have to be used at least once a day for 3 months before results become noticeable. As part of the treatment avoid those activities that contribute to nail dryness; use of nail polish and frequent contact with water and detergents.
Native American medicine
More than anything, some Native Americans applied a philosophical way of dealing with life's adversities. The philosophy is called the four moods, mainly:
RUTHLESS
because alopecia is ruthless and so must I be to fight for my self-esteem.
CUNNING
because I'm so good at fooling myself, and others, into believing everything is fine when it really isn't. I have to outsmart or even trick myself.
PATIENT
I have to go through it, get through it- this takes time- but still I will heal eventually.
SWEET
I must not get callous, not with myslef or with others. So I'll be nice to myself to balance out the ruthlessness.
Neural (nerve) hypothesis
Some researchers believe that alopecia areata is the result of a defect in the innervation of the skin. The evidence for this hypothesis is found in reports of abnormal electroencephalographic recordings, the frequent complain of itching, and the microscopic examination of distorted nerve endings in patients with alopecia areata.
Nioxin
A herbal based hair product geared towards the thinning hair and excessive daily hair loss market. It is not a drug (more of a shampoo) and therefore requires no medical supervision. This product is not to be confused with Nixon, our former president, who also suffered from male pattern baldness. If you need any further information the Nioxin people have a toll-free number 800-628-9890.
Nitrogen Mustard
A family of chemical compounds normally used in cancer therapy. Although one of the side effects of the medication is hair loss, it has paradoxically been used in trials for alopecia areata with favorable results. Side effects of the medication include hyperpigmentation and contact sensitization.
Non-beneficial Treatment
There have been a number of trials with medications having a negative therapeutic response in patients with alopecia areata. Among these non-beneficial compounds are calcipotriol (a vitamin D analogue), interferon alpha-2, croton oil, sodium lauryl sulfate, griseofulvin, topical tretinoin, and benzyl benzoate/phenol (both irritants). In this regard two articles by Tosti and others are worth mentioning (J Am Acad Dermatology 15:209-210, 1986; J Am Acad Dermatology 24:455-456, 1991). In one of the studies patients with patchy alopecia areata were divided into subgroups and given squaric acid dibutylester, diphencyprone, topical minoxidil, or placebo. After 6 months of continuous treatment no difference was noted between groups. Similarly, another study by the same group proved the uselessness of treating AT/AU patients previously unresponsive to 1 year of sensitizing therapy.In this study there was no single cosmetically acceptable improvement in treatment outcome when the population was divided and treated variously with cyclosporin, PUVA, or thymopentin.
Nude mice
In 1966, the nu mutation waws firts reported in mice in Glascow, Scotland. Mice with the nu mutation are homozygous recessive for the "nude" gene. The mutation produces a hairless state, thus generating the name "nude". Two years later, it was also discovered that the homozygous nude mice lacked a functional thymus and reduced numbers of mature T cells. Despite the T cell immunodeficiency, the nude mouse has a normal complement of bone-marrow dependent B cells. The spontaneous mutation of nu led to the nude mouse becoming the first animal model of severe immunodeficiency.

O

Oils
Some oils are massaged into the scalp a few times a week before bedtime. They are said to stimulate circulation to the scalp. More importantly, massaging the scalp is a great stress reliever after a long day (whether you wear a wig or not).
  • bringraj and amla oil (these are Indian oils)
  • rosemary essential oil + lavender oil (for relaxing purposes): it is good to mix with almond oil.
  • The ever important EUCALYPTUS OIL for those pesky dust mites. It is used to wash clothes, linen, and when cleaning the apartment. (See also aromatherapy).
Ointment
The ointment serves as the vehicle by which active pharmacologic agents have been added to produce a therapeutic effect when applied to the skin. They are semisolid preparations that produce a more complete film over the skin surface; they protect and occlude the skin surface and also have a hydrating effect, impeding water loss from the skin. Medicinal agents can be added to ointments for the purpose of absorption. Ointments may be classified into three types: water-soluble, emulsifiable, and water-repellent. Water-soluble ointments are usually polyethylene glycol preparations. Emulsifiable ointments include water-in-oil emulsions and absorbent ointments.

Ointment vehicles usually provide better topical penetration of incorporated drugs than do creams or lotions because of their occlusive nature. They are applied one to several times daily and increasing the number of applications will favorably impact on the rate and degree of improvement. They should be gently massaged into the skin area to the point of disappearance of the material.

Omega 3 fatty acids
There is a lot of evidence now accumulating about the beneficial effects of omega 3 fatty acids in non-communicable diseases such as cancer, Alzheimer's disease and autoimmune conditions. Omega 3 fatty acids has a special role in coronary artery disease because it sterifies (i.e., the formation of an ester bond between the sterol ring and the fatty acid) cholesterol and mobilizes the same! Sterification with saturated fatty acids (or even triglycerides) does not mobilize the cholesterol, but rather propitiates its deposition. This is a controversial issue and some people attribute the reduction of heart disease with diet supplemented by omega 3 to reduce platelet aggregability. Omega 3 has an antiinflammatory effect and has proven beneficial in rheumathoid arthritis and ulcerative colitis (see Dictionary section for definition). It has also proven of benefit in systemic lupus eryhematosus (at least the murine model of the condition).

I don't know how omega 3 fatty acids work to suppress an autoimmune reaction. However, several years ago I read an article by Rotondo on Faty Acid Modulation of Cell Responsiveness which was quite illuminating (J Lipid Research 34(8):291-295,1993). The article argued in favor of modulating the autoimmune resonse by

  1. Interference with the flow of arachidonic acid for eicosanoid biosynthesis,
  2. Modulation of intracellular regulatory mechanisms, and
  3. Alteration of membrane fluidity.

I do believe that for somebody with AA who has recovered his/her hair there may be some benefit in taking omega 3 fatty acids in order to suppress the autimmune reaction. Omega 3 fatty acids won't however act as a trigger to promote hair growth once you lost it.

Many people talk about omega 3 fatty acids as fish oil which is really not the truth. Omega 3 is manufactured in plants, including green algae. Fish eat the green algae and store in large amounts the omega 3 fatty acids which is needed for cell membrane fluidity (the water where they live is cold).That is why the North Atlantic salmon is high in omega 3 fatty acids- it eats a lot of algae on its way north. Farm fish do not have the omega 3 fatty acids because they are not fed correctly. Similarly the fish in your supermarket store has minimal amounts of omega 3 fatty acids because, a) it has been farm raised, 2) it has been cut to ribbons and exposed to the air enabling the fatty acids to oxidize. That is why I go to the fish market to buy fish and not to Kroegers or Food Lion. Just remember, if its in slabs it should be fresh and look pink, any darkish discoloration means oxidation. Salmon, sardines, herring and mackerel are among the fish with highest levels of omega 3-fatty acids. If fish isn't in your diet you can obtain omega 3-fatty acids from flax seed oil (see dictionary), evening primrose oil, or balck currant oil. If given the choice I would select black curant oil or borage oil over evening primrose oil because of their higher concentration of GLA (gamma-linolenic acid, an anti-inflammatory essential fatty acid used in the treatment of rheumathoid arthritis and multiple sclerosis). Stay away from taking fish oil capsules as they may be contaminated with toxins and don't provide the same benefits as eating the right kind of fish. Borage seed has the most GLA in it, next is black currant. Generally speaking it takes about 6 same-size evening primrose oil caps to equal one borage seed oil cap, in terms of getting the same amount of GLA.

Omega-3 EFAs are:

  • alpha-linolenic acid (ALA)
  • eicosapentaenoic acid (EPA)
  • docosahexaenoic acid (DHA)

Flaxseed oil has ALA in it. ALA is *not* an active omega-3, but the body should convert some of it to EPA, and some of the EPA should be converted to DHA. ALA is lower down the chain, and DHA is the top of the chain. You can obtain these products at your local natural health food sore, from Vitacost (formerly The Vitamin Connection) at 1-800-793-2601, or via the net at http://www.vitacost.com/.

As I have stated in other portions of this FAQs, with my own daughter, I have avoided "invasive" therapies and have concentrated on desensitizing her for her allergies and providing a healthy dose of antioxidants (plus omega 3 fatty acids). The fact about omega 3 is just plain being healthy. The World Food Organization (yes there is such an organization) recommends at least 3 fish meal per week. The same can't be fried as once you go over 200 degrees the fatty acids are destroyed. If you don't like fish, you can obtain a healthy supply from linseed oil in your health and nutrition store. Primrose oil is also a good source of omega 3 fatty acids, but more so of omega 6 fatty acids which is not as good.

I could possibly bet that in a country such as India, that rely on a vegetarian diet, alopecia areata may not be as frequent or severe as in industrialized nations such as the United States. Plants provide for the omega 3 fatty acids and also antioxidants, as for example beta carotenne.

So far (always looking) the best borage seed oil softgels I've found are made by Source Naturals. One of them is called SuperGLA, 500-mg capsule, and has 90-mg of GLA, 200-mg linoleic acid, + vit-E and in a sunflower seed oil base. If any parent reading this is wondering how to get a softgel down the throat of a young child, my best advice is DON'T TRY IT. Cut the capsule open, mix it immediately with some food (like *natural* peanut butter or yogurt or mashed banana or taters or whatever), feed the child, and whammo you've done the impossible !!!!

Oral contraceptives
Diffuse hair shedding has sometimes been reported some 3 to 4 weeks after oral contraceptives have been discontinued.

My own particular opinion is that hair loss due to contraceptive usage is somewhat similar to the phenomenon described as telogen effluvium. The term referes to changes in the hair cycle of an individual. In the normal hair cycle the large majority of follicles are in a stage of growth, only a minority enter a resting stage called telogen. The use of exogenous estrogens may help to synchronize the hair cycle in such a way that a larger than normal portion of hairs enter the telogen phase. The end result is thinning of hair.

Oral contraceptives have an antiandrogenic effect. They apparently do so through several different mechanisms the best known of which is by acting on the brain to suppress the action of gonadotropins. Some contraceptives are better than others at reducing the levels of androgens. Chemical compounds known as progestins and given in different proportions with estrogens in contraceptives, have androgenic properties. Anyway, I believe that the fact that estrogens synchronize the hair cycle may be a more important/pertinent factor in hair loss than their antiandrogenetic or androgenetic properties.

Oregon grape root
Prevention magazine had an article (1999) about an herbal treatment for eczema, psoriasis and blepharitis (an eczema-like inflammation of the eyelids).

Based on new clinical observations, Douglas Schar, DipPhyt, MCPP, a London- based herbalist specializing in disease-preventing herbal medicines, found that Oregon grape root may be a safe, effective treatment for chronic skin problems.

Schar prescribed the herb to 300 people with blepharitis. After three months, 95 % said that their symptoms improved significantly. He is now monitoring 1,000 people who are still doing well.

No double-blind studies exist to prove that Oregon grape helps skin problems or why, but Schar has a theory: "The herb contains berberine, which we know constricts capillaries. In inflammatory skin conditions, capillaries dilate and fluids seep into surrounding tissues. Oregon grape seems to reduce the tendency toward inflammation," he says.

The key to success is long-term use. You have to wait two to three months to see improvements," Schar says, "and you should plan to take the herb for up to a year for more lasting results.

Dosage: Oregon grape root can be taken two ways: As a tincture: 1 1/2 tsp. twice a day or as a tea: Drink 1/2 c. twice a day (Prepare the tea by boiling 3/5 g (2 tsps) of Oregon grape root bark in 4 ounces of water for 5 minutes. Strain and sip).

Orphan medication
The term oprhan is used to describe condition where there are no effective medications. This applies primarily to "rare" or uncommon conditions affecting up to 200,000 patients. There are fewer incentives for manufacturers to develop trials for orphan conditions as they usually end up losing money. In order to overcome this the government created a law providing tax credit to companies that performed trials using orphan medications. It is my understanding that regulatory authorities are more efficient in processing the paperwork and require less patients in a trial before approval.

P

Pantothenic acid
One of the B-complex vitamins. It is widely distributed in many different types of food, so its deficiency is highly unusual. Experimental deficiency of this essential vitamin in rats has caused graying of dark hair followed by alopecia. Other symptoms of pantothenic acid deficiency include fatigue, headaches, diarrhea and vomiting. Supplementation of diet with pantothenic acid, however, does not prevent the natural greying of human hair with ageing. Advocates of pantothenic acid supplementation in alopecia areata have used it in conjunction with nicain and scalp massaging. The therapy is presumably directed at enhancing scalp circulation.
Patch test
A test used to determine hypersensitivity to a substance which has come in contact with the skin. It is imposible to test a person for all possible allergen; rather, the clinician guides himself/herself by the history of the patient to select those he/she deems appropriate.
Pelade hairs
A short hair sometimes found at the margin of active alopecia areata lesions. The hairs are on the average of 0.2 to 0.7 cm long and have little pigmentation. Their proximal ends are tapered or clubbed. Some authors consider them as prognostically unfavorable.
Pepper shampoo
Cayenne pepper has a history of correcting hair loss. I was skeptical about using straight cayenne pepper on the scalp because if it is potent as a spice in foods it will most likely be an extreme irritant to her head. In my research I found a pepper shampoo which contains a rich blend of pure horsetail, red and green peppers, burdock, rosemary, nettles, Aloe Vera, plus pro vitamin B5. The shampoo can be used with nightly aromatherapy massage. Some people have experienced regrowth with this method. In some cases blondish regrowth hair slowly turns black. The shampoo is by Spanish Garden, "Original Pepper Shampoo" You can purchase it at www.pennherb.com. I use a soft newborn brush to lather it on the scalp. (See also aromathrapy and herbal remedies)
Pernicious anemia
A severe anemia (decreased production of blood) caused by failure of the stomach to produce intrinsic factor which is needed by the body to absorb vitamin B12 which is necessary to produce blood.
Phenol
A chemical, known as carbolic acid, which is flammable, corrosive, and very toxic. Phenolic compounds have a distinct odor and are used in disinfectants, deodorizers, paints, and as anesthetic for skin. Ingestion of small amounts may cause vomiting, circulatory collapse, paralysis, convulsions, and coma. Phenol rapidly denatures all proteins it comes in contact with, including skin. Anesthetic properties of phenols can allow extensive damage to skin tissue before pain is perceived. In the past phenol was used as a skin irritant for patients with alopecia areata. It is not very effective and its use has been superseded by the introduction of other compounds (see the section on irritants). Phenols can depigment the skin leaving a white patch behind. It can also damage nerve endings producing a temporary anesthesia. If absorbed systemically, phenols can produce glomerulonephritis (kidney damage).
Photodynamic therapy
This is an experimental procedure where a drug (verteporfin) is injected and then activated in specific places with the use of a laser beam. Presumably the drug then releases electrons which transforms surroounding molecules into toxic entities. The end result in this cascade is that the toxic molecules kill any surrounding cells. The obvious uses are for destroying unwanted tissues in specific places (i.e., tumors) and in treating macular degeneration in the eye. However, it is also being applied in experimental fashion to psoriasis and organ transplant (i.e., skin grafts). Some people believe that verteporfin selectively impairs part of the immune system called the Langerhans cells.
Poliosis
A localized lack of pigmentation in hair. This phenomenon is seen in both vitiligo and alopecia areata. If the cells (melanocytes) that produce the hair pigment have been destroyed hair coloring may be the only way to restore the original color.
Polycystic ovary syndrome
A syndrome first described by Stein and Leventhal in 1935 that associated menstrual irregularities with hirsutism (excessive facial and body hair), obesity and enlarged polycystic ovaries. The condition is causes a state of anovulation to persist for a certain period of time.
Propecia
The drug Proscar (used to fight porstate problem) is also marketed as Propecia (a word play with Alopecia). The active chemical is called finasteride and works by turning off an enzyme called type II 5 alpha reductase (5-a-R). The enzyme is found to a minor degree in the scalp hair follicles and is necessary for the conversion of testosterone (T) to dihydrotestosterone (DHT). DHT is an "active" form of T and causes hair follicles to miniaturize ("shrink"). The common belief is that by inhibiting 5-a-R the levels of DHT which can bind to hair follicle receptors is diminished/inhibited, ergo hair can regrow.

Systemically the enzyme needed to produce the male hormone dihydrotestosterone which promotes prostate growth. At least initially the drug is being sold by prescription. Women are cautioned because of birth defect risks. Propecia can cause birth defects -- "unrecognizable genitalia" for male babies. These women are even cautioned against touching (literally) broken tablets!!! Side effects in men include decreased sexual desire, partial impotence and other reductions in sexual performance. The problems seem to disappear after the medication is discontinued. As with Rogain the indication appears to be male pattern alopecia, not alopecia areata. The pharmaceutical trial submitted to the FDA showed efficacy for hair regrowth in the vertex and anterior mid-scalp areas but no bitemporal efficacy has been established. This means that the drug won't help those people with a receding hairline. For those that work, I presume, that the drug won't provide a cure for the condition but rather temporary regrowth.

In case you're going ahead and thinking about trying it anyway, why not try saw palmetto instead (obtained at natural health food stores). It's certainly less expensive, does the same thing Proscar does for an enlarged prostate gland, and is believed to work exactly like the drug by inhibiting 5-a-R.

Pruritus
This is the medical term for itching. Pruritus may be symptomatic of an active phase of the condition (alopecia areata) or it can be the primary symptom of a coexisting atopic dermatitis.
Pseudopelade
A type of scarring alopecia that slowly progresses to irregular areas of hair loss without prior skin disease. It is slowly progressive and shows no evidence of folliculitis or marked inflammation. Pseudopelade is generally regarded as a clinical syndrome which may be the end result of diseases such as, lichen planopilaris, chronic discoid lupus erythematosus, scleroderma, or folliculitis decalvans. Pseudopalade may be a primary autoimmune atrophy of hair follicles as numerous lymphocytes can be found around the upper third of the follicles. Initial clinical features present themselves as small bald patches that appear smooth, soft, and slightly depressed (atrophic skin). At an early stage in the development of any individual patch there may be some erythema. The fact that it is scarring means that a lot of connective tissue (i.e., fibrotic tissue) develops in the scalp usually as a reaction to inflammation. The attendant fibrosis reduces the chances for potential regrowth. This is in contrast to nonscarring alopecia where the hair follicles are preserved or resting.
Psoralens
Constituents of plants (Psoralen corylifolia, etc.). Exposure to substances containing psoralens and then to sunlight may produce photoxic dermatitis.
Psoriasis
The name referes to plaques with silvery scales that are often seen in the scalp, elbows, knees and gluteal folds. Similar to lichen planus the lesions may acquire a linear distribution. Nail changes are common and include pitting and a yellowish discoloration that resembles a fungal infection. Psoriasis may cause hair loss but it is distinguished from alopecia areata for being diffuse, inflammatory, and scaling.
Puberty
There have been several studies commenting on puberty and prognosis. Muller and Winkelman reviewed 736 pts with AA at the mayo clinic and reported 54% of the kids and 24% of the adults developed AT. They found the percent developing AT declined as you got older. Walker and Rothman studied 230 pts at the Univ of Chicago and found that if you developed AA before puberty, 50% developed AT and none fully recovered If you developed AA after puberty, 23% developed AT and 5% fully recovered. Those with AT tend to remain that way.
Pulse steroids
Pulse steroid treatment means the use of high doses of steroid (oral or intravenous) given over one or several days instead of lower doses given every day. This treatment seems to increase the response and lower the complications of the therapy and is used in arthritis, dermatomyositis and connective tissue diseases. If pulse steroids are not effective after 4-6 trials, serious thought should be devoted to consider stopping the treatment.

I would avoid pulse steroids under the following conditions; diabetes, history of tuberculosis, adverse prior reaction to steroids, kids under 12 years of age, glaucoma that is porrly controlled, tachycardia, heart disease, and any history or disease that can be exacerbated by steroids or where steroids are contraindicated.

Pycnogenol
Pycnogenol (proanthrocyanidins) several years ago is supposed to be a very powerful antioxidant (15 to 25 times stronger than Vitamin E) that neutralizes free radicals. I viewed slides of blood using a dark field microscope and saw the effect that free radicals can have on the blood. It can cause malformation of the RBCs making them clump together, thus reducing their effectiveness. Some naturalists recommend that you use pycnogenol having both the pine bark and the grape seed extracts, as they contain different and synergistic bioflavonoids. Pycnogenol has been recommended for the treatment of cancer. If a tumor mass is being successfully treated by certain chemotherapies, the lack of vascularization in the tumor will result in the tumor cells inability to rid waste products, effectively poisoning the surrounding cells. Proanthrocyanodins are one of only a few antioxidants that cross the blood brain barrier. Proanthrocyanodins have also been indicated for the treatment of allergies, hay fever, PMS, ADD, Chronic Fatigue Syndrome, menstrual cramps, and muscle soreness. (See also DMSO)

Found this in PubMed: Proanthocyanidins from grape seeds promote proliferation of mouse hair follicle cells in vitro and convert hair cycle in vivo. Takahashi T, Kamiya T, Yokoo Y Tsukuba Research Laboratories, Kyowa Hakko Kogyo Co., Ibaraki, Japan. Acta Derm Venereol 1998 Nov;78(6):428-32

For the purpose of discovering natural products which possess hair growing activity, we examined about 1000 kinds of plant extracts concerning growth-promoting activity with respect to hair follicle cells. After an extensive search, we discovered that proanthocyanidins extracted from grape seeds promote proliferation of hair follicle cells isolated from mice by about 230% relative to controls (100%); and that proanthocyanidins possess remarkable hair-cycle-converting activity from the telogen phase to the anagen phase in C3H mice in vivo test systems. The profile of the active fraction of the proanthocyanidins was elucidated by thiolytic degradation and tannase hydrolysis. We found that the constitutive monomers were epicatechin and catechin; and that the degree of polymerization was 3.5. We demonstrated the possibility of using the proanthocyanidins extracted from grape seeds as agents inducing hair growth.

R

Rational Emotive Therapy (RET)
This is cognitive behavioral therapy, meaning working on what we tell ourselves and changing our behavior. The therapy is based in the belief that all feelings are derived from our cognition (thoughts). Meaning, every feeling is preeceded by a thought. Change the thought and you change the feeling.

The therapy deals a lot with identifying irrational thoughts and replacing them with rational ones. Examples:

  • Irrational: I must be liked and approved by everyone I meet.
  • Rational: Not everyone is my cup of tea and I can't be their's.
  • Irrational: I must be perfect.
  • Rational: I'm human so I should give myself at least a 15% margin of error.

By identifying self-defeating thoughts (which I call a run-away horse) and replacing them with forward thinking (pulling the reins on that run-away horse and gently steering it in the right direction) we feel more in control of ourselves and better able to deal with life's circumstances. We all know we can't always control what happens to us. What we do have ultimate control over is how we choose to experience things.

Renbeok phenomenon
The renbeok phenomenon is the reverse of the koebner phenomenon. The koebner phenomenon occurs when an injury to the skin induces a skin disease to develop at the site of the cut, scrape or other damage that has happened to the cutaneous surface. This is very common in psoriasis, lichen planus, molluscum, warts and other skin diseases where these diseases will develop at a site of injury in a person who usually has pre-existing disease. In AA sometimes hair will regrow in area of pre-existing disease, e.g in psoriasis. So in this instance a normal condition (hair regrowth) will re-establish itself in an area that has become diseased (affected with psoriasis). This is the reverse of the koebner phenomenon and has been coined the renbeok phenomenon by Rudolf Happle, MD, a very famous AA researcher of Marburg, Germany.
Retinoids (vitamin A)
Derivatives of the fat soluble vitamin A which is required for proper bone development, night vision, and skin integrity. Frequently reported adverse effects with systemic administration of retinoids include hair loss (including eyebrows and eyelashes), dry nose, palmar peeling, and chapped lips. These side effects are slowly reversible upon discontinuation of the medication. Retinoids are used in clinical practice in the treatment of acne and psoriasis. It has also been combined with minoxidil for the treatment of androgenetic type of alopecia. Some people speculate that the retinoids enhance the absorption of minoxidil into the hair follicle.
Rogaine
(see minoxidil)
Rosemary
"Rosemary's main attribute is its association with all functions of the head. Extract of rosemary in shampoos and hair tonics revitalizes the scalp, prevents dandruff, and encourages new and healthy hair growth with a shining lustre." All of this comes from the book "Herbs -- Their Cultivation and Usage" by John and Rosemary Hemphill. See also aromatherapy and herbal remedies in this dictionary.

Here are some recipes. …

Wash for the hair

  • 4 fl oz lavender water
  • 1/2 oz borax
  • 3 oz rosewater
  • 1/4 oz tincture of cochineal

After washing the hair in this solution, rinse well, with a little borax in the last water. this wash is particularly good for oily hair.

Tonic and restorative for the hair 1

Infuse in vinegar: rosemary, sage, southernwood. Allow to stand in bottle in a sunny window for 7 or 8 days before straining.

Tonic and restorative for the hair 2

Infuse in olive oil: sage, thyme, marjoram and balm (all "live-for-ever" herbs). Prepare as for above recipe. Rub a little into scalp before shampooing.

Sage hair tonic

1 tablespoon each of tea and dried sage. Put into 2lb jam jar, cover with boiling water, and simmer for 2 hours. Rub into scalp 4 or 5 times a week. Gradually greyness will disappear, and hair will become dark brown. Add 1 tablespoonful of rum, gin, or Eau-de-Cologne for longer keeping.

Most of these herbs putatively act as nerve sedatives, aid in digestion, help coughs and colds, are used for poor skin, and as a heart and kidney tonic.

Rudeness
A recent news release by Associated Press referred to our President, "In the right light- and at certain camera angles- the pink flesh of Clinton's head shines through his feathered hairdo. Thick thatches of hair in front and on the sides give way to thinner trails atop and back." Although a whole scenario could be constructed around stress and alopecia, I think this particular piece of news stresses more than anything bad journalism. It seems that political bias makes journalists go after people in order to discredit them. The object of ridicule in this case is not what the President is saying, but his thinning hair. In the old days editorials were found in the editorial page. Younger reporters don't understand the difference between reporting and editorializing, or for that matter, between good journalism and plain rudeness.

S

Saw palmetto
The botanical name for saw palmetto is Serenoa repens, the genus/species is Serenoa Repens. The plant is also known as Sabal in some countries. According to the Saw Palmetto Harvesting Company the benefits of the plant can be traced to aborigines of the Florida peninsula who depended largely upon the berries to treat atrophy of the testes, impotence and low libido.There have been some claims of benefit of saw palmetto (serenoa repens) in patients with androgenetic alopecia. It is also recommended for prostate problems. The connection is the control of androgens. Much the same way a side effect of Proscar is hair growth, saw palmetto, by restricting the production of male sex hormones could result in hair growth in patients with androgenetic alopecia.
Scarring alopecia
Inflammation of the hair follicles can lead to scarring alopecia. This form of alopecia is easy to identify because rough patches on the surface of the scalp made up of small blood vessels and tissue are present. Scarring alopecia has many different causes such as discoid lupus erythematosus. In this condition, the skin becomes smooth, atrophic, and scarred. Other skin diseases which lead to scarring alopecia are lichen planus, pseudopelade of Brocq, and aplasia cutis congenita.
SCAT
Treatment regimens with the irritant antrhalin range from applying the product for 1/2 hour only (SCAT-short contact anthralin therapy) to leaving the product on for 12 hours or more.
Schmidt's syndrome
(See also autoimmune polyglandular syndrome) An interesting case report by Mueller-Schoop JW and Meyer M in Lancet 1996;348:1420 relates the history of a patient who developed alopecia totalis in 1990. Four years later the patient developed pain, stiffness and weakness of the legs. In 1995 the woman was diagnosed with diabetes mellitus. It was the concurrence of these severe disorders that prompted her physicians to look for a possible link among them. After laboratories tests showed abnormalities (mild hypothyroidism, antibodies against cell nuclei, etc) she was diagnosed with multiple endocrine insufficiency (Schmidt's syndrome) of which alopecia totalis can also be a feature. Interestingly she was treated with cyclosporin and prednisone and her hair grew back (she later lost her regrowth after discontinuing her medications).
Seasonal rhinitis
Inflammation of the nose as an allergic reaction to weeds, pollen, grasses, etc that are abundant during certain seasons.
Section 504
Section 504 of the rehabilitation Act of 1973 is geared towards insuring that students with special needs receive the accomodations or services required enabling them to receive the benefit from public education. It is enforced by the Office of Civil Rights but many Advocacy organizations are fully involved. In our case the section may best apply to children who claim a hat or wig is necessary for school participation. Theoretically the local public school may even be prompted to provide for funding for this purpose.
Selenium
Selenium is an essential micronutrient in the human diet that functions as a component of enzymes involved in antioxidant protection and thyroid hormone metabolism. In combination with vitamin E, it exerts antioxidant effects that help keep the immune system strong. Recent studies indicate that selenium may increase immune response which can help alopecia patients. However, in chronic intakes of high amounts selenium was linked to skin, hair, and nail abnormalities.

A worker who was employed by a company in Lucknow, India that manufactured and maintained drums used in photocopy machines developed AA and later became AU. In his case, it was determined to be caused by exposure to a selenium alloy used for the drums, and it showed up in his blood and nails.

Semodex
Semodex products are now available from Nioxin to treat baldness "facilitated" by demodex folliculorum mites. There is a shampoo, stabilizing tonic, scalp serum and cleansing liquid for implements. Salons should be carrying it very soon. The products do not come cheap (starter kit, salon charge $100). I went to a professional supply store to watch the video. The video indicates that demodex is very difficult to kill and feasts on oil and tender young hairs at the root. For some great color shots of the beasties, go to the Nioxin Research Labs.
Skin Biopsy
I haven't had the need to use a biopsy to diagnose alopecia areata. Usually a firm diagnosis is based on both the history and physical examination. There are special circumstances that merit skin biopsy. Recurrent attacks of alopecia areata presenting as diffuse rather than patchy hair loss, or the concurrence of conditions that may promote hair loss (e.g. hypo or hyperthyroidism). In other cases a biopsy may help determine proper treatment. If the biopsy reveals a lot of inflammation the doctor may recommend te use of corticosteroids, lack of inflammatory cells may promote other types of therapies.

My own use of biopsies has been solely for research purposes. Thus far I had sixteen biopsies in my scalp and 1 in my forearm. I have had no complication in any of them. The one in my arm has taken a slightly pinkish coloration and looks like a mosquito bite.

The procedure can be described as follows:

The skin is wiped with 70% alcohol and a local anesthetic (lidocaine 0.5% or 1.0%) is injected under the skin using a 1 ml syringe with a 26- to 30-gauge needle. Patients allergic to lidocaine are given Benadryl instead. The outline of the wheal is marked with a pen. After about 30 seconds a skin punch is driven by twisting and pushing into the skin. After attaining the proper depth (the whole extent of the dermis), the punch is withdrawn. The edge of the skin plug is then be grasped with a forceps and pulled outwards. Tissue holding the base of the plug is then cut with either scissors or a scalpel.

Risks from a skin biopsy can usually be classified as those involving pain, bleeding, and/or infection. Although pain is minimal, a local anesthetic (i.e., subcutaneous lidocaine) is used to numb the biopsy site. Lidocaine (1%) is a local anesthetic which may have side effects such as urticaria, edema, lightheadedness, and dizziness. More serious adverse effects, such as hypotension, bradycardia, confusion and convulsions have been reported rarely, and are associated with other methods of administration. The minimum recommended dose for percutaneous infiltration is 1 ml according to the Physician's Desk Reference. The punch biopsy is a quick and practically painless procedure where a very small area ~3mm2X2mm deep- of skin is removed. Bleeding is minimal and easily controlled by appl0.ying a bandaid.

To limit the risk of infection, the skin is cleaned with alcohol and the biopsy is performed with sterile (disposable) instruments. There is also a risk for keloid formation and excessive bleeding. Those subjects with a positive history for either of the latter risks should be warned about possible consequences. The small wound is kept dry for 48 hours and inspected for complications by the patient every day for three days. The patient is usually instructed that the biopsy heals with a slight scar. The borders of the incision are irregular and generally slightly smaller than the size of the punch. After a few months, the initial pinkish coloration at the site of the biopsy will become skin color or lighter making it even less noticeable.

Skin mosaicism
Our skin is not uniform. It is patchwork quilt where each patch is derived from a different message as to where the cells should migrate and what they should develop into (skin, sweat glands, hair, etc.). As a result of these different messages, embryonic skin cells divide to form the skin surface- the descendants of the original embryonic cell will keep the original properties. Consequently some patches of skin may be more susceptible than others to disruption. For hair specifically, we know that the hair follicle cells of the ophiasis region (around the sides of the head) come from distincly different embryonic cells than those on the top of the head. It is tempting to suggest that alopecia areata limited to the ophiasis area is a result of this subtle distinction in cell type.

Related to this I would like to add that hair follicles react differently to hormones depending on their location in the body. For instance, the male hormone will cause scalp hair loss yet encourage facial hair to grow profusely (i.e., longer and thicker). It is also very commmon for women with female pattern alopecia to experience a slight increase in pigmented chin, abdomen and chest hair while their scalp hair thins out.

Soaps (Detergents)
A cleaning compound that works by emulsifying fat from the skin surface. Many types of soap are harsh to the skin and promote dryness if used excessively. Those having an alkaline pH may irritate sensitive skin. Patients that have eczema of the hands will find it useful to use soap substitutes like emulsifying ointments and aqueous creams.
Sperm shampoo
According to Sean Connery, human sperm shampoo grows hair. I've got a feeling that if Mr. 007 had used the stuff in the 1960's, the story line fo all of those James Bond movies could have been slightly different. $30,000 per kilo!!! That breaks down to about $880 per ounce. Even if it works, who can afford to buy it?
Spironolactone
This is a potassium sparring diuretic with antiandrogenic effects. It is most commonly used for acne and there has also been some success in treatment of a subset of patients with Chronic Fatigue Syndrome. Its use for androgenetic alopecia is primarily anecdotal as no large alopecia trials have been conducted. Women have taken the medication orally. Lately more men have been applying a 2% mixture in alcohol to combat dihydrotestosterone (DHT) binding to receptors in the hair follicle to stop male pattern baldness.
Squill
A herbal remedy with putative hair regrowing qualitites has squill as its major ingridient. Squill's a member of the liliaceae family and can be found in many gardens around the word, specially in Europe and Africa. It has poisonous properties but is also used in many medications. Red squill, a type of squill, is used as a rat poison. Ingesting squill could prove dangerous but its nauseating quality may reduce potential complications (apparently rats can't throw-up). Exposure can cause a bitter taste, nausea, vomitting, abdominal pain and blurred vision. Higher levels can cause serious heart rhythm disturbances or convulsions. Squill is also a cardiac stimulant and diuretic. Herbal books recommend its use to treat asthma, bronchial ailments, bronchitis, cancer, catarrh, cathartic, dropsy, edema, gout, pneumonia, rheumatism, tumor, and wounds.

For the record, regarding squill and its metabolite (scilliroside): There are *no* blood chemistry or urine tests to identify scilliroside metabolites after exposure. There have *never* been any studies to determine DNA mutations, teratogenic (birth defects), or carcinogenic effects after exposure -- long-term or otherwise. To my mind, one or two years of applying a squill-based cream to your scalp or skin is extremely long-term exposure.

Several govt agencies in the US declared red squill a hazardous substance many years ago. One warning issued was that it should *not* come in contact with skin. Actually, it's not even used for rat poisoning in the US anymore, not since the 1980s.

You might find a little extra info at Plants for a Future.

Stork bite
A nuchal nevus flammeus is a collection of vessels that arte dilated and flush with emotions or exercise or other stimuli. They usually resolve on their own except in the nuchal area. Yes, they are what you see on babies, sometimes in their face, eyelida, etc. They are also called angel kisses. They usually fade after one year. The stork bites can fade but often persist, in varying degrees.

In AU the "stork bite" (red marks on the back of your neck), also known as a nuchal nevus flammeus is present about 44% of the time. The general population has it about 20% of the time. When the nuchal nevus flammeus is present there is often a higher incidence AT/AU but some physicians feel that this association may be spurious.

Stria
A streak-like depression of the skin caused by loss of connective tissue.
Suppressor cells
A cell in the blood that inhibits the action of other lymphocytes (normally after fighting infection and providing immunity).
Synthroid (levothyroxine (T4) sodium, USP)
Synthroid is synthetic T4, a hormone identical to that produced in the human thyroid gland. This stands in contrast to ARMOUR THYROID tablets, USP. Natural preparations derived from porcine (swine) thyroid glands.

Some side effects of synthroid include a partial hair loss that may occur rarely during the first few months of therapy, but it is usually temporary. Synthroid has also been implicated in causing osteoporosis. If you have been taking Synthroid chronically, consider request a bone density measurement test to establish a baseline now. Dual Energy X-ray Absorptiometry (DEXA) is one way to measure bone mineral density, and it's suppose to be safe. DEXA uses less radiation and is much less expensive than CT scans, so hopefully your friend's doc will see the rationale in agreeing to it and/or automatically recommend it.

Also, below is a snippet from another List member's post:

“Went for all types of blood tests and found that I have Hashimoto's thyroid disease and a multinodular goiter...I was put on Synthroid (T4) but still experienced severe hair loss. Doctor then found that T4 would not convert to T3 so he switched me to Armour Thyroid (T4 & T3). I have been on Armour since January and hair finally stopped falling out in April. Anyone who suspects hair loss due to thyroid please make sure your doctor checks ALL thyroid hormones including the Free T3.”

Systemic lupus erythematosus
An autoimmune disease occurring mainly among middle-aged women and causes inflammation of various parts of the body, especially the skin, joints, and kidneys. Lupus is difficult to diagnose because it includes diverse clinical presentations and because no clinical or laboratory finding is specific for lupus.Below are the symptoms in order from most to least common. A person should have four or more of these symptoms to suspect lupus, yet these symptoms do not all have to occur at the same time:
  • Achy joints (arthralgia)
  • Fever over 100 degrees F
  • Prolonged or extreme fatigue
  • Arthritis (swollen joints)
  • Skin rashes
  • Anemia
  • Kidney Involvement (i.e. protein in the urine)
  • Pain in the chest on deep breathing (pleurisy)
  • Butterfly shaped rash across the cheeks and nose
  • Sun or light sensitivity (photosensitivity)
  • Alopecia
  • Raynaud's phenomenon (fingers turning white or blue)
  • Seizures
  • Mouth or nose ulcers

See also antinuclear antibodies (ANA).

T

Tacrolimus (also known as FK506)
An immunosuppressant drug sparingly used in the treatment of alopecia areata. It was discovered in the late 1980's as a derivative of a soil fungus. In a study done by Marine Biotechnology Institute of Kamaisha Laboratories in Iwate, Japan, the clinicians concluded that the anagen hair induction caused by tacrolimus is NOT the result of immunosuppression but of some other function. Its major use is to prolong the survival of transplanted grafts by inhibiting T cell activation. In this regard it acts similarly to cyclosporin (see Dictionary). By applying it topically you don't really get the many side effects of oral ingestion. The worst part of it is that the drug is compounded in a petroleum jelly, meaning that you will spend the better part of your days and nights with rather greasy hair. The compound itself is being investigated for use in patients with atopic dermatitis. The research is focusing primarily on children because if ther condition continues after 6 years of age there is a poor porgnosis for outgrowing it.

There are several preclinical studies claiming that tacrolimus is more potent than cyclosporin, it is also not irritating, sensitizing, and has a very low systemic absorption (when applied topically). This includes trials of patients using it on the face where it would provide a major advantage over other therapeutic modalities such as corticosteroids. Most of the trial that I know haven't followed patients for a very long period of time (lets say 10 years). I am sure that someone will be looking at long term side effects as dermatitis tends to be a chronic condition that requires multiple and continous treatment. It appears, at least on paper, that Tacrolimus holds a good promise for symptomatic treatment although it would fall quite short of being a cure.

Animal studies showed hair regrowth in animal models of AA. Some human studies have not been properly controlled studies nor have they been extensive. They were pilot studies. No published human studies showed benefit from any topical use other than one study that showed regrowth when oral Tacrolimus (FK506) was combined with oral steroids. Other human and animal studies of oral FK506 showed no benefit. When one of the patients in a clinical trial for alopecia asked his Dermatologist about the success rate of the medication, the physician answered that BOTH of his patients had been unsuccessfull!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! If you tape the !!!!! marks to your forehead it would probably provide a better esthetical result (resembling hair) than using this drug. Again, I emphasize that the drug's only promise is for temporary regrowth, not as a cure for the condition.

Tanning
An increase in pigment production by the skin. The process decreases the amount of ultraviolet light acting on the skin.
Target growth
In many patients with alopecia areata the bald patches have begun to grow hair back in the center as they continue to lose hair at their edges. The hair looks like a target with a bull's eye in the center (hair regrowth) and a pink (skin) ring around it.
Telogen
The resting phase of the life cycle of the hair. This phase lasts for 3-4 months and ends as new hairs push out (shed) the old telogen hairs.

It is interesting to note that when rats or mice shed (our typical animal models for study) they do it more or less all at once, but in a "wave". Head to toe, so to speak. So, basically *all* of their hair is in one stage at any given moment. Also unlike humans, their hair doesn't automatically fall out after telogen. It takes new hair (fur) growing in to push the old hairs out. Typically for humans, about 10% of our scalp hair is in telogen at the same time, but not in one distinct area - rather evenly over the entire head.

Terminal hair
Long coarse hairs that are pigmented, fully developed, and found on the scalp, beard, pubic and axillary regions but absent on palms, soles, glans and prepuce. Their growth is influenced by circulating androgen levels.
Thallium
A heavy metal whose accidental or suicidal ingestion has been associated to alopecia. Hair loss is diffuse and occurs some 15 to 30 days after ingestion. Thallium is found in rodenticides. Toxicity has also been reported from overuse of depillatory agents. Symptoms in the less severe intoxications include ataxia (incordination), weakness, somnolence, tremors and headaches. In severe cases death has been attributed to cerebral and renal damage.
Thymoma
Alopecia areata has been related to tumors of the chest called "thymomas". This is a tumor of the gland that generates T lymphocytes (i.e., the cells that recognize foreign agents/proteins). They are sometimes detected incidentally as a mass in the anterior part of chest because one-third of affected individuals are asymptomatic. The presence of this tumor is usually associated to myasthenia gravis (see Dictionary for definition).
Thymopentin
A man made pentapeptide that modulates the function of the immune system. Clinical trials have shown moderate success in propitiating hair regrowth for patients with alopecia areata. No complications of thymopentin therapy have been reported.
Thymus
The thymus gland is the primary organ involved in lymphocyte (Tcell) differentiation. It is also an endocrine organ that produces thymulin, a hormone also involved in lymphocyte differentiation. There is an increased incidence of alopecia areata in people who are hypothymic (low thymus function) or athymic (no thymus function). Studies have shown that the lower levels of thymulin, the greater the disease activity, i.e., persons with AU have lower levels of thymulin than those with AA. It is not yet known how this is related to alopecia. Incidentally the thymulin assay is regarded as a marker of zinc status- thymulin is a zinc dependent hormone (see Zinc as a term in the Dictionary Section).

Ref. Prasad AS, Meftah S, Abdallah J, et al. (1988) Serum thymulin in human zinc deficiency. J Clin Invest 82(4):1202-1210.

Thymuskin
This commercial product is an extract from calf thymus (Yarel Biological Corp., 1-800-257-5602). It is supposed to act in alopecia areata by boosting the body's own thymus gland function. According to the company ingestion of thymus extract helps by normalizing the creation of the follicle's autoantigens. Although Thymuskin has a lengthy literature in the Net, every sentence dealing with a scientific fact regarding its mode of action requires a leap of faith in order to accept it.

I found it interesting that at the bottom of their web page, in the smallest print imaginable (I had a LOT of trouble reading it and I have a *big* monitor) it reads: “Nothing presented here shall be construed as a claim or representation that ThymuSkin Cosmetics … are intended for the diagnosis, treatment, cure, or mitigation of any disease.”

They're sort of talking out of "both sides of their mouth" at the same time, if you catch my meaning. Saying it will work, it's proven to work, but we won't guarantee it. And, if you try it and it doesn't work, it's your loss not ours.

I ask myself, if something (ThymuSkin) has such a proven track record of success (67% men/94% women) then why not offer a refund to the small percentage for whom it won't work. Sounds like a good business practice to me, if it was truly so successful, as *they* present it to be.

Thyroid
A gland in the neck near the voice box responsible for producing thyroid hormone. This hormone regulates the metabolism of the body.
Thyroiditis (Hashimoto's)
Inflammation of the thyroid gland as result of antibodies which attack ones own thyroid cells.
Thyroid tests
Tests that
  1. evaluate the function of the thyroid gland,
  2. measure the products secreted by the thyroid,
  3. examine the hypothalamaic-pituitary-thyroid axis, or
  4. test for other thyroid related proteins in serum.

The usual panel of tests include total and free T4, T3, and thyroid-stimulating hormone (TSH).

Tinea capitis
A fungal infection of the hair shaft usually nicknamed "ringworm" of the scalp. It usually manifests itself as a sharply marginated patch of partial hair loss in a child. In recent years It has ben reported with increasing frequency in adults.

The fungus invades the hair shaft and causes the hairs to break. Inflammation and scaling may be present. Treatment requires application of topical anti-fungal creams, washing of the hair with Nizoral shampoo, as well as oral anti-fungal medication (Griseofulvin), usually for a period of 2 months.

The infection may be transmitted through combs, brushes, barrettes, pomades, bed linen, stuffed toys and from person to person. Most children are not contagious if under treatment, and may attend school.

Topical
This referes to the application of medicines over a particular surface area. Any response is then supposed to be localized to the particular area to which the medication is applied. I disagree with those Dermatologists who consider scalp injections as topical and without systemic side effects.
Topical irritants
Anything applied to the skin that causes redness, swelling, itching, blistering. Think poison ivy.
Trichogen
This is a Chinese alopecia areata pill distributed within the United States by the China National Chemical Imports and Export Corporation. Prescriptions may be obtained from practitioners of Chinese traditional medicine (if you want to obtain one in your area call the Institute for Traditional Medicine in Portland, Oregon (503)233-4907. The usual course is 6 pills taken three times daily in a treatment regimen that takes 600 pills. (See also Chinese medicine)
Trichology
(From the Greek word trichos meaning hair) A para-medical degree in England and Australia that is approximately equivalent to a Masters degree. It takes 6 years to obtain full certification (3 years theory and 3 years practice). It is confered through the Institute of Trichologists.

Trichology is the science of the hair and scalp and originated in Britain at the turn of the century as a para-medical branch of Dermatology. It provides advice and treatments for all hair and scalp types and problems, including; hair loss (all conditions), general hair care, dandruff, scalp oiliness, etc. They provide advice for lifestyle benefits to naturally help the hair or scalp without the use of prescription medication, i.e., diet, vitamins, exercise, relaxation, etc. (although they do refer patients to physicians for medication, if necessary). Trichology is an holistic science in that it recognizes that a healthy hair and scalp is dependent on the health of the body, and vice versa.

A problem with trichologists (as with other specialty disciplines) is that some are more qualified than others in the sense of keeping up with rapidly developing research, etc. Also, some specialize in cosmetic problems while others in dandruff, in counseling patients who are having a difficult time dealing with their hair loss, performing clinical trials, etc.

Trichothiodystrophy
A rare autosomal recessive disorder characterized by sparse and brittle hair reduced sulfur-rich amino acid content, scaliness, peculiar face, mental and growth retardation.
Trichotillomania
A form of hair loss caused by pulling, twisting, or rubbing. Hair loss tends to be localized and the resulting patch is angular in configuration. Trichotillomania affects pre-pubertal boys and girls at about an equal ratio, however, it affects post-pubertal girls/women (particularly teenagers) about 2 to 6 times more than men! Initially, a person with the condition rarely admits that they pull their hair either due to embarrassment and/or because they don't realise that they are doing it. Many people consider trichotillomania to be part of the obsessive-compulsive disorder spectrum. Treatment involves a mixture of counseling, cutting the hair short (so that it can not be pulled), and medications.

Some patients with trichotillomania may be misdiagnosed as alopecia areata and vice versa. The bald patches in trichotillomania may be fairly oval and the short broken hairs left after pulling resemble exclamation mark hairs. Also, George et al., in the New England Journal of Medicine found that over 50% of bulimia patients were liable to have trichotillomania and, interestingly enough, those patients were not only more reluctant to talk about their trichotillomania than their bullimia (another reason for a misdiagnosis by an inexperienced clinician).

Triparanol
A drug which disturbs keratinization by inhibiting cholesterol synthesis. Scalp and body hair becomes dry, sparse, and light in color. Skin is generally dry and scaly.
Tropho-Neurotic theory of alopecia areata
Although there is a comprehensive network of nerve fibers around hair follicles, and in some regions of the follicle there intimate contact, there is no apparent need for nerve stimulation to activate (or inhibit) hair growth. I guess this bring up a past theory of alopecia areata. Max Joseph and Co. did some experiments in 1890 something or other where they cut the posterior branch of the second cervical nerve and recorded the development of alopecia over the area of distribution that this nerve served. They suggested thus that nerve stimulation was required for hair growth, better known as the Tropho-Neurotic Theory of alopecia. However, in 1928 Dr Wright repeated the experiments in animals and humans with no hair loss at all.

The eventual conclusion was that Dr Joseph was actually observing hair loss as a result of the cats scratching their hair, and each others, out around the site of surgery as a result of the stress induced by the procedure. This psychological barbering is common in many species under stress. Of course without nerves to send feed back about the scratching and any damage it was doing, the cats could scratch away at this site all day without feeling any pain.

Type A and B personalities
Type A personalities are hard driving, goal oriented, upright and likely to die of a heart atack. They are more aggressive, often more angry types.

Type B personalities are more laid back. Who knows what type C personalities are? I've never known any!

Tyrosine kinase B
An article in New Scientist, 1999 March 06, describes the experiment of a German physician Dr. Paus. Using mice he discovered two substances that work by binding to tyrosine kinase B. If humans have a similar system, then drugs that block the receptor could prevent hair loss. Alternatively, drugs that mimic the brain proteins and bind to the receptor might help people shed unwanted hair.

U-V

Urticaria
Some of the members of our list server have asked whether there is a relationship between urticaria (or hives as it is called in England) and alopecia areata. I don't know the answer but the question remains an interesting one.

The primary lesion in urticaria is a wheal that grows and coalesce with its neighbors. The wheals are a transitory phenomenon that manifest themselves in terms of minutes to hours only to change in shape or disappear altogether. Itching may be quite severe. Any urticaria that is present for less than 12 weeks is arbitrarily classified as acute while eruptions of longer duration are called chronic. In some cases urticaria is a side effect of medications, in others it may accompany a viral infection. Still, the underlying mechanism is unknown. Some cases are thought to be due to a reaction involving IgE antibodies. These are the same type of antibodies that mediate atopic reactions, e.g., allergies, dermatitis, asthma, etc. Since 40% of patients with alopecia areata suffer from an atopic condition (as compared to 20% of the general population) it seems possible that urticaria may be an occassional concurrent condition for patients with alopecia areata. Treatment is with H1-antihistamines but with continued dosages tolerance to the antihistamine will develop.

Two case histories may be illustrative:

Case history 1

“I have suffered from chronic "hives" since I was 22. I'm 38 now. I get them every 2 to 3 years and it takes a good 6 months to get rid of them. I became AA 4 years ago and just recently started getting hives again. I manage them with Atarax and every now and then a 6 day Medrol dose pack to kick start the system. I've also had psoraisis since I was 18. No doctor has linked my skin maladies with my hair loss as of yet.”

Case history 2

“Just to share my daughter's experiences...Beth has AA since 5/96, and is 12 yrs old. She has experienced hives on one occasion, a severe case requiring a trip to the emergency room (4 yrs old). We could find no apparent cause. Hers were so bad, her skin actually bruised when the welts went away.”

Vaccinations (see also Hepatitis B)
A recent abastract in the Journal of the American medical Society [Wise RP, Kiminyo KP, Salive ME: JAMA 1997 Oct 8;278(14):1176-1178] examined the problem of hair loss after routine immunizations. The study came from the Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Md 20852-1448, USA. The study design was based on a case series (Review of spontaneous reports to the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Vaccine Adverse Event Reporting System) with telephone follow-ups. The authors concluded that, "There may be an association, probably very rare, between vaccinations and hair loss. More than 1 pathophysiologic mechanism may be responsible. Since apparently nonrandom distributions by vaccine, age, and sex could reflect biased case ascertainment, further research will be needed in defined populations with consistent case detection."
Vacuum wigs
The original vacuum was made of fiber glass and most today are made of silicone. An impression of the head is taken with plaster bandages. The reason it works is because the head is wider on the sides and narrower at the nape. This shape causes a vacuum fit when properly placed on the head. You will find that the vacuum hairpiece is warmer than net pieces because of it's inability to breathe. Most last three years but will need repairs. The vacuum is the most secure of all hairpieces but is for total loss and not patches.
Vellous hair
Fine short hairs covering most of the body surface (absent in soles, palms and parts of the genitalia). Vellous hair replaces lanugo (see Dictitonary definition) shortly after birth and may be transformed into terminal hairs under the influence of androgens.
Virgin hair
How does your hair loose its virginity? An ad in a magazine stated that their wigs were made from 100% virgin european hair. Now I can't even say the word wig in a conversation without thinking about this.
Vitamin B12
See cyanocobalamine.
Vitamin D
Vitamin D is manufactured by the body under the influence of UV rays. In its active form vitamin D is a steroid hormone with some anti-inflammatory properties. There's some speculation that active vitamin D may be involved in the production and/or secretion of the hormone insulin and that it might also assist in regulating normal immune function. How vitamin D fits in the alopecia picture, I don't know. However, some alopecians sprout fuzzies when they get a tan (UV therapy?). Also chidlren born with vitamin D receptor defect have alopecia. One small child with vitamin D recetor defect exhibited no symptoms until his mother stopped nursing him.
Vitiligo
A skin disorder characterized by smooth, irregular white patches of the skin caused by the loss of the natural pigment. The peak incidence occurs during childhood to mid adult life. Affected areas commonly include the dorsal surface of the hands, the area around the eyes and mouth, and the axilla. At least 10% of patients with vitiligo have evidence of another coexisting autoimmune condition,e.g., Addison's disease, diabetes mellitus (type I), thyroid disease, pernicious anemia, uveitis, or alopecia areata. Some information regarding a vitiligo support group can be obtained from vitiligo@sjuvm.stjohns.edu or you can join directly to their list server at listserv@sjuvm.stjohns.edu. The address for the National Vitiligo Foundation is: P.O. Box 6337, Tyler TX 75711, phone, (903) 531-0074, Fax (903) 531-9767, Email: vitiligo@trimofran.org.
Viviscal
Another putative hair growth chemical obtained from a marine extract and developed in Finland. It consists of tablets (2 a day) and it is also recommended you use their scalp lotion applied once a day and their shampoo 2 - 3 times a week. Ingridients include:
  • Extract mixture of marine origin 60% (300 mg)
  • Acerola-extract 24% (120mg)
  • Silicaceous earth/silicic acid 6% (30 Mg)
  • microcrysatlline cellulose
  • Mg-stearate
  • Natural Blackcurrant flavour

I understand Viviscal is not classed as a 'drug' and therefore does not require FDA approval. The product should be used for a least 6 months before assessing treatment efficacy. It is available in the US. A study with positive results was published by Lassus A, Eskelinen E J Int Med Res, 20: 6, 1992 Nov, 445-53. To my knowledge there have been no follow-up articles. Some of our members who have tried it reported that it was both very expensive and ineffective.

Vogt-Koyanagi-Harada syndrome
This is a systemic disease causing inflammation of the eyes. It is more common in darkly pigmented people, affects the eyes, coverings of the brain, and skin. Clinical symptoms include eye pain, redness, blurred vision, hair loss, headaches, vitiligo and ringing of the ears. Treatment is with topical and/or systemic corticosteroids.

W-Z

Xerosis (dry skin)
This is the medical term for dry, rough, cracking, scaly skin. The condition produces itching and may be exacerbated by exposure to the sun, saunas, whirlpools, and harsh soaps. Friction often aggravates the condition,e.g., around ankles or plantar areas. Treatment involves rehydrating the skin and sealing it with an emollient. Take short baths with lukewarm water, use a mild superfatted soap, pat dry the skin (rather than rub it dry) and use moisturizers liberally.
Zapper
What we called the zapper is officially named the Master High Frequency Unit from from International, 1919 Stanley St., Northbrook, IL 60062-5324. They are probably wholesalers, so you may have to order one thru a beauty supply house. It's a plastic handle with electronic innards that plugs into an outlet. A glass rod comes out the other end with a flat, round "bulb." When turned on the glass glows purple and electricity "tingles" the scalp. You need to follow directions carefully. There is no scientific validity to claims that this gadget will grow hair. Current Technology Corporation in Vancouver, Canada have promoted the benefits of electrical stimulation for hair growth. At present, they don't seem focused on obtaining FDA approval for use of their equipment within the United States. Treatments can be obtained outside of the United States (Mexico and Canada) at a rather steep price ($50 for a 12 minute session).
Zinc
A mineral whose deficiency causes hair loss. Nutritional deficiency is most commonly seen in a hospital setting when a patient is given parenteral (injected rather than oral) alimentation. Other dermatological changes include redness of the skin, scaling, and the formation of large vesicles. In guinea-pigs zinc deficiency results in depression with abnormal posture, scaly skin lesions on various parts of the body, edematous swelling of the hind limbs, marked alopecia and depletion of serum thyroid hormones.

Some people CANNOT absorb zinc, or only absorb it poorly. A deficiency of this trace metal can be inherited as a recessive trait in acrodermatitis enteropathica. CELIAC DISEASE, Crohn's disease, sickle cell anemia, diuretics, and oral contraceptives all interfere with zinc's absorption and metabolism. In addition, women on "the pill" who who supplement their vitamins with folic acid are at a special risk for zinc depletion. Large doses of folic acid lower zinc concentrations in the blood, making them prone to a zinc deficiency. Also, calcium bicarbonate found in hard tap water interferes with zinc's absorption and utilization.

Some people have advocated zinc deficiency in the pathogenesis of alopecia areata. These people believe that zinc supplementation may be of benefit by modulating the immune system and causing an overall increase in the total number of CD8 cells (supressors) (Lutz G, Kreysel HW in Z Hautkr 65(2):132-4, 137-8, 1990). Results with zinc supplementation have been variable, at least one controlled study showed no improvement in disease severity or activity. The trials showed that results, if positive, were obtained after prolonged periods of zinc supplementation (8 months) and that discontinuation of the mineral was followed by loss of the re-aquired hair. If you decide to use zinc, supplement your copper intake. Zinc and copper interfere with each others absorption and deficiencies of either one can produce alopecia. Acute zinc toxicity can be induced by ingestion of >200 mg in a single day. Toxicity is manifested by abdominal pain, nausea, vomiting, and diarrhea. Unfortunately there isn't an accepted test that serves as a reliable indicator of zinc status. In high concentrations zinc may act as an inhibitor of dihydrotestosterone and some people advocate its use in conjunction with vitamin B6 in the treatment of androgenetic type of alopecia. If you decide on taking zinc supplementation, be sure to take it with other food but not with other multivitamins and minerals. Zinc can upset an empty stomach and other vitamin/minerals can retard its absorption.