Abstract
Patients with severe biotinidase deficiency (BD), if untreated, may exhibit seizures, psychomotor delay, deafness, ataxia, visual pathology, conjunctivitis, alopecia (hair loss), and dermatitis. Clinical features normally appear within the first months of life, between two and five. Seizures are one of the most common symptoms in these patients (55%), usually presented as generalized tonic-clonic, and improving within 24 h of biotin treatment. Treatment delay has been associated with irreversible neurological damage, mental retardation, ataxia, paraparesis, deafness, and epilepsy exceptionally.We report the case of a girl who was admitted at 2.5 months because of vomiting, failure to thrive, flexor spasms, dermatitis, and neurological depression for 1 month. BD was identified and was treated with biotin, stopping seizures and improving symptoms. Developmental delay, paraparesis, optic atrophy, and seizures during febrile illness were observed at follow-up. At the age of 8, she suffered hemigeneralized seizures despite appropriate biotin treatment, so levetiracetam was administered, and epilepsy was controlled. Organic acid measurement was performed to determine whether the child was receiving enough or no biotin.Even though BD is a rare condition, because the biotinidase screening is a reliable procedure and the disorder is readily treatable, the implementation of extended biotinidase screening will effectively help to prevent any acute and long-term neurological problems as well as the significant morbidity associated with untreated disease. In addition, neonatal screening and early treatment with biotin prevents severe neurological sequelae, such as epilepsy, which has not been thoroughly described in the literature.

Affiliation

Department of Dermatology, B1-Q, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands UKCC (Bahrain Branch), College of Medicine, AMA International University of Bahrain, Awali, Bahrain North Wales Centre for Primary Care Research, Bangor University, Wrexham, U.K.

Female pattern hair loss is the most common type of hair loss affecting women with reduced hair density. It is characterized by progressive replacement of slow cycling terminal hair follicles by miniaturized, rapidly cycling vellus hair follicles. The frontal hair line may or may not be preserved. The aim of this review was to assess the evidence for the effectiveness and safety of the treatments available for FPHL. Pooled data from four studies indicated that a greater proportion of participants treated with minoxidil reported a moderate increase in their hair regrowth compared with placebo (relative risk 1·86, 95% confidence interval 1·42-2·43). There was no difference between the number of adverse events experienced in the twice daily minoxidil and the placebo intervention groups, except for a reported increase with minoxidil 5% twice daily for hair loss. Single studies accounted for most of the other comparisons, which were assessed as either having high risk of bias and/or they did not address the prespecified outcomes for this review and provided limited evidence of either the effectiveness or safety of these interventions. Further well-designed, adequately powered randomized controlled trials investigating other hair loss treatment options are still required.

Menopausal-type symptoms among breast cancer patients on aromatase inhibitor therapy.

Gallicchio L,
Abstract

Objectives To examine self-reported menopausal-type symptoms among breast cancer patients on aromatase inhibitors (AIs) compared to women of the same age who had not been diagnosed with cancer, and to determine whether the percentage of breast cancer patients experiencing these symptoms changed over the first 6 months of AI treatment. Methods Data from a 6-month cohort study of 100 breast cancer patients initiating AI therapy and of 200 women of a similar age without a history of cancer were analyzed. At baseline (prior to the initiation of AI therapy among the breast cancer patients), 3 months, and 6 months, a comprehensive questionnaire was administered to participants that ascertained data on the experiencing of specific menopausal-type symptoms. Results The data showed statistically significant increases in the prevalence of certain symptoms from baseline to either follow-up point among the breast cancer patients; these symptoms included hot flushes, night sweats, pain during intercourse, hair loss, forgetfulness, depression, difficulty falling asleep, and interrupted sleep. Additionally, breast cancer patients were more likely than the women in the comparison group to report the new onset of many of these same symptoms during the follow-up time period. Conclusions Because bothersome symptoms and side-effects are a major reason for discontinuation and non-adherence to treatment, symptoms should be monitored and addressed by oncologists so that the breast cancer patient can maintain her quality of life and remain adherent to the treatment schedule.

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Treatment of chemotherapy-induced alopecia.

Yeager CE, Olsen EA.

Chemotherapy-induced alopecia has been well documented as a cause of distress to patients undergoing cancer treatment. Despite the importance of hair loss to patients, however, patients often receive little more counseling than the advice to purchase a wig or other head covering for the duration of their treatment. Research into non-camouflage (wigs, turbans, and head scarves) treatment methods have been complicated both by a lack of a standardized methodology for evaluating hair loss and hair regrowth and by a lack of human trials. Nevertheless, scalp cooling as a method of preventing hair loss during chemotherapy and 2% topical minoxidil as a therapy for accelerating regrowth after chemotherapy are both effective non-camouflage options for treatment. Other proposed treatments for prevention of hair loss during chemotherapy have demonstrated promise in early trials, but these findings will need validation from rigorous further studies. The increasing number of reports of permanent alopecia not just with pre-bone marrow transplant, high-dose busulfan, and cyclophosphamide regimens but also with standard breast cancer chemotherapy regimens illustrates the importance of further research into treatment methods for chemotherapy-induced hair loss.

Castro-Magana M, et al

We studied the testicular function and some androgen-mediated events in 22 males with male pattern hair loss treated with finasteride for 2 years. snip… Serum gonadotropin, prostate-specific antigen (PSA), and sex hormone levels were determined basally and periodically during the treatment period. Fourteen subjects underwent gonadal stimulation with human chorionic gonadotropin, and the gonadotropin response to gonadotropin releasing hormone was determined in eight subjects, prior to and after 2 years of therapy. Finasteride treatment resulted in an improvement in the male pattern hair loss and prostatic shrinkage that was associated with an increase in serum testosterone levels and a decrease in dihydrotestosterone levels, causing a marked increase in that testosterone/DHT ratio. A significant increase in the serum levels of androstenedione and estradiol snip.. No changes in basal or stimulated levels of gonadotropin were observed. There was a significant increase in the testosterone response to hCG during finasteride therapy that could be explained, at least in part, by the reduction of testosterone metabolism resulting from the blockage induced by finasteride. The decrease in the androstenedione to testosterone and estrone to estradiol ratios observed after hCG treatment, however, strongly suggests increased activity of the 17-ketosteroid reductase enzyme and an improvement of the testicular capacity for testosterone production.
hair loss and hair loss regrowth

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Response of alopecia areata to DNCB: influence of auto-antibodies and route of sensitization.

Friedmann PS.
The effects of treatment with topical 2,4-dinitrochlorobenzene (DNCB) were observed in fifty-one patients with alopecia areata of at least 9 months duration. Patients were sensitized either by the application of 500 micrograms of DNCB in acetone to the forearm, or by painting affected areas of the left side of the scalp with a 1% solution. A mild to moderate dermatitis was maintained by weekly applications of DNCB. When the sensitizing dose was applied directly to the scalp, significantly more patients showed poor reactivity as judged by the eczematous response obtained, although the two routes of sensitization had comparable effects upon regrowth of hair. Hair regrew significantly more frequently in females. The likelihood of hair regrowth was reduced in patients with hair loss of long duration and in those with immunological disturbances such as autoantibodies or low T lymphocyte numbers and responses. The relationship of these factors to the disease and to the response to DNCB treatment is discussed.

Hair restoration in the ethnic patient and review of hair transplant fundamentals.
Lam SM, Karamanovski E.

Willow Bend Wellness Center, Lam Facial Plastic Surgery Center and Hair Restoration Institute, Plano, TX 75093, USA

Abstract
Superior hair restoration requires the application of universal principles along with variations that apply to specific ethnic populations. This article serves as a primer on basic tenets of hair restoration, with additional attention given to the uniqueness and differences in technique and design that are warranted for a wide range of races and ethnicities. This article also gives prospective surgeons an insight on how to undertake further study and shore up their deficiencies so as to refine knowledge gaps and ensure patient safety and excellent surgical outcomes. Copyright 2010 Elsevier Inc. All rights reserved.

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