Alternative Medicine for Hair Loss

Hair Loss Black Book

Learn how one medical researcher and former hair-loss sufferer is helping both men and women to: Discover what is Really causing your hair loss. and eliminate this problem once and for all at the source. Stop wasting your money on prescriptions, procedures, and miracle products that are messy, dangerous, and down-right ineffective. Stop Hair Loss Permanently and re-grow your hair with your own, natural hair growth cycle. Restore your confidence, your youth and your charisma. Eliminate everyones stares and stop them from thinking about your thinning hair and your receding hair line Read more...

Hair Loss Black Book Summary

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Peruvian Hair Loss Treatment That Really

Components of this formula: Component #1. My mother (who was peasant and lived 90 years) used this plant since young woman to eliminate dandruff and keep her hair, long, lustrous and healthy. The plant is cheap and easy to find anywhere. Component #2. This plant used since ancient times as hair loss treatment, promote health and the growth of the hair, stimulates energetically the capillary circulation, restoring life and strength to the hair. This plant has revealed the ability to stop the conversion of testosterone to dihydrotestosterone, that is to say, to reduce the excessive degrees of dihydrotestosterone (Dht) that has serious effect on hair loss that face men and females. Component #3. This ancient plant used mainly in India and China (now found in any market) has been used in foods but not for hair loss treatment. Investigating and analyzing, I found however, that the plant has marked properties to irrigate, to nourish and to give life to the hair and using it in my formula results are excellent. Component #4. It is a powerful bactericidal, biocide, fungicide and natural antibiotic with electrical properties that prevents that the follicle rots for causes of seborrhea, dandruff or other and prevents hair loss. Component #5. It is a powerful natural nutrient for all hair types containing high doses of vitamins and essential acids for health and beauty of hair, Such as: Vitamin B5: Prevents hair loss and premature graying. Vitamin B6: Create melanin and prevents hair loss. Biotin : May prevent graying and hair loss Inositol: Supports to cellular level strong and healthy follicles. Produces keratin. Niacin: Promotes capillary circulation Read more...

Peruvian Hair Loss Treatment That Really Summary

Official Website: stophairlossnaturalsolution.com
Price: $27.00

Dermatological Abnormalities Hirsutism Acne and Androgenic Alopecia

Acne has been reported to affect 12-14 of white PCOS patients (10,60), although the prevalence of this dermatological abnormality also varies with ethnicity. It is reportedly higher in Asian Indians (60) and lower in Pacific Islanders (58). Androgenic alopecia is a recognized sign of PCOS (61-63) however, in a study of 257 androgen excess patients undergoing treatment, only 12 (4.7 ) complained of hair loss only (10). Overall, acne and androgenic alopecia apparently have a low prevalence among patients with PCOS. Because studies quantifying and determining the prevalence of acne and androgenic alopecia in a significant number of unselected patients with PCOS are lacking, we did not include these disorders in our calculations of economic burden.

Hair Loss

Our culture places great importance on hair and its appearance. Hair loss can cause embarrassment and loss of self-esteem. Your hair grows continually for 2 to 6 years, then rests for 2 or 3 months before falling out naturally. Shedding 50 to 100 hairs each day is a normal process, and each shed hair is replaced by There are many different types of hair loss, with a number of different causes. Hair A high fever or severe infection can produce hair loss, as can an overactive or underactive thyroid gland. Other causes of hair loss include an inadequate amount of protein in your diet, iron deficiency, or cancer treatment. Certain prescription medications such as those for gout, arthritis, depression, heart disease, or high blood pressure can cause hair loss in some people. Large doses of vitamin A also can cause hair loss. If you notice that your hair is falling out in large amounts after you brush or comb your hair, see your doctor as soon as possible to determine the cause. For men,...

Mitoxantrone Novantrone

Cardiomyopathy is dose-dependent and may be as great as 6 in patients receiving 140mg m2 or less 47 . Prior to each infusion, patients should have an echocardiogram to evaluate their ejection fraction. Delayed effects of mitoxantrone on cardiac function have been reported. Antiemetic premedication (with ondansetron) may alleviate nausea during and for several days after infusion. Alopecia, amenorrhea, and infertility may also occur. Mitoxantrone is teratogenic. Leukemia occurs in approximately 1 of patients and generally responds to treatment.

StearoylCoA desaturase SCD

Are resistant to diet-induced obesity, have lowered plasma VLDL and TG levels, and show increased energy expenditure and insulin sensitivity 80-82 . However, in addition to these favorable phenotypic components, SCDl-deficient mice develop cutaneous abnormalities including alopecia and narrow eye fissure 83 . More recently, pharmacological inhibition of SCD1 in mice with SCD1 antisense oligonucleotides has recapitulated characteristics of the KO animal, such as the improved insulin sensitivity and resistance to diet-induced obesity, in the absence of alopecia 84 .

Other Dermatologic Problems

The typical facies of hypohidrotic (anhidrotic) ectodermal dysplasia is seen in this infant. Note the alopecia, absent eyebrows and eyelashes, square forehead with frontal bossing, hyperpigmented wrinkles around the eyes, flattened nasal bridge, and large conspicuous nostrils. There are wide cheek bones with depressed cheeks, thick everted lips, a prominent chin, and the ears may be small and pointed. These infants have a thin dry skin, decreased sweating, decreased tearing, and abnormal dentition. The nails are defective in a large percentage of these patients in that they may be thin, brittle, or ridged. If the absence of the sweat glands is generalized, they may have recurrent fever in high environmental temperatures.

Mammalian orthoreovirus 1Lang MRV

Experimental infection of mice causes jaundice, alopecia, conjunctivitis and 'oily hair' associated with steatorrhea. The mice appear to have been dipped in oil, and if newborn mice are infected their growth is stunted and they become runts. There is no clear association with disease in humans and infections are usually symptomless.

When To Suspect An Endocrine Disorder In Acne Patients

Although hormones influence acne, most acne patients do not have an endocrine disorder. Hyperandrogenism should be considered in female patients whose acne is severe, sudden in its onset, or is associated with hirsutism, or irregular menstrual periods. Additional clinical signs of hyperandrogenism include Cushinoid features, increased libido, clitoromegaly, deepening of the voice, acanthosis nigricans, or androgenetic alopecia. Women with hyperandrogenism may also have insulin resistance. They are at risk for the development of diabetes and cardiovascular disease. It is therefore important for the long-term health of these patients to identify hyperandrogenism so that they can receive appropriate therapy from an endo-crinologist or gynecologist.

Oligoadenylate synthetase 25OAS

O'Nyong-Nyong virus (ONNV) A species in the genus Alphavirus. The complete nucleotide sequence shows a close genetic relationship to Semliki Forest virus. In humans it causes a febrile illness with lymphadenitis, severe joint pains and rash. Epidemic spread occurs with anopheline mosquitoes as vector. Occurs in Uganda, Kenya, Tanzania, Malawi and Senegal. Pathogenic for suckling mice given i.c. older mice are resistant. Infant mice which survive the infection are stunted and show patchy alopecia. Virus is propagated in chick embryo fibroblast cell cultures.

Summary of Predictive Value of Clinical Markers

Overall, between 50 and 75 of women with evidence of hirsutism or the complaint of unwanted hair growth will have androgen excess, notably PCOS. Alternatively, only 20 and 40 of patients with acne as their sole presenting complaint and only about 10 of women complaining of hair loss will have androgen excess. Between one-fourth and one-third of women with oligo- amenorrhea have androgen excess, and only about one-fifth of women with polycystic ovaries on ultrasonography will have androgen excess.

New Therapies From Existing Drugs

History is replete with examples of compounds that were originally developed for one disease and subsequently found to be beneficial in another. In contrast to the hypothesis-driven philosophy of modern drug discovery, many highly successful new treatments have been discovered by serendipity 3,5,12-14 . The phosphodiesterase (PDE-5) inhibitor, sildenafil for example was originally developed as a potential anti-angina therapy but was observed during early clinical trials to be efficacious for male erectile dysfunction, for which it was subsequently first approved. Further studies on sildenafil have expanded its label to include approval for pulmonary arterial hypertension. The alpha-2 adrenergic agonist, brimonidine, was originally synthesized as an anti-hypertensive and later discovered and marketed as an anti-glaucoma agent. Further examples of drugs with unexpected benefits beyond their initially approved indications include bupropion, which is approved as a smoking cessation drug,...

Temporal Separate Incisions

The temporal incision allows an easy undermining of the crow's-feet area, a meticulous hemostasis, and the downward flap permits the hairline to be maintained in the in proper position. But sometimes, especially in smokers, there is a partial transient alopecia in front of the incision, or even a skin slough.

Hair Replacement Surgery

Hair replacement surgery for male pattern baldness is one of the most common cosmetic surgery procedures performed on men. Usually it involves grafting hair from the sides and back of the person's scalp (called the donor sites) to the bald area. Sometimes this technique is combined with another procedure called scalp reduction, in which the surgeon removes skin from bald areas of the scalp and uses elastic scalp extenders and expanders placed under the skin to stretch the remaining skin over the scalp. In another surgical procedure, called the flap technique, the surgeon moves areas of the scalp containing hair from the sides or back of the head to the top of the head. The flaps cover more area than the usual graft, and part of the flap remains attached to the original blood supply. The type of hair replacement procedure you choose depends on the kind of hair loss you have. If you are considering hair replacement surgery, discuss your options with your plastic surgeon to determine the...

StearoylcoA Desaturases

Criture Cursive Flech

Well as fatty liver diseases, such as steatosis and nonalcoholic steato-hepatatis (NASH) 12-16 . However, mechanism-based side effects have been reported and appear to be due to a deficit of unsaturated FAs in peripheral tissues like skin and pancreas 9,17 . Reported skin side effects included loss of hair (alopecia) and eye fissure 18 . Additionally, using antisense oligonucleotides to inhibit SCD in a mouse model of hyperlipi-demia and atherosclerosis (LDLr- - Apob100 100), it has been demonstrated that SCD inhibition increased atherosclerosis independently of improvements in obesity and insulin resistance and argued against SCD1 inhibition as a safe therapeutic approach for treatment of the metabolic syndrome 19 . The development of atherosclerosis could not be prevented with dietary oleic acid. However, in a follow-up study, fish oils were able to fully prevent the development of atherosclerosis following SCD inhibition. It is proposed that fish oils antagonize the inflammatory...

Diacylglyceride Oacyltransferases

Criture Cursive Flech

An HTS followed by lead optimization of a resulting hit afforded a novel structural motif represented by ureido piperazine 18 that was potent in a biochemical assay (IC50 20 nM, recombinant human DGAT1) as well as in a cell-based assay (IC50 80 nM, DGAT1 expressed in 3T3-L1 cells) 50 . Compound 18 reduced adiposity and improved insulin sensitivity based on an oral glucose tolerance test after chronic administration to C56Bl6 mice maintained on a high-fat diet. However, untoward side effects of sebaceous gland atrophy and hair loss were observed. In a separate study, compound 18 decreased plasma TG levels and increased circulating GLP-1 levels in dogs after acute oral administration 50 .

Evaluation of 100 Cases

Top Reconstructive Ear Surgeons

The scar remained well-hidden, being restricted to the retroauricular area. In five patients, retroauricu-lar skin folds were observed, especially at the beginning of our experience. These gradually improved, and only one required revision (Fig. 47.10). There was no hair loss in the undermined retroauricular scalp area, whereas some temporary hair loss was observed in the temporal area in about 10 of patients. Two hypertrophic scars were observed, creating a few folds. No patient complained of pain or sensitivity problems in the retroauricular area.

The Subperiosteal Browlift

Screw Endoforehead Lift

Most surgeons today practicing aesthetic surgery advocate an endoscopic subperiosteal technique for elevation of the brow and elimination of the glabella furrows and wrinkles 1-10 . The reason for this is of course the ability to avoid the bicoronal scar with possible hair loss 7, 11 , the avoidance of transection of the supraorbital nerves and the subsequent numbness of the scalp behind the scar. The transection of the supraorbital nerves at the incision is also believed to be the cause of a prolonged period of itching of the scalp. The bicoronal subgaleal browlift also gives the patient a markedly raised hairline, usually in the ratio of 2-3 times the distance the eyebrows are elevated 12 . there will be a depression after muscle resectioning in the glabella area as experience tells us that this does not occur. The resected area is filled out rather quickly with fibrous tissue. After ensuring that all bleeding has stopped and inspecting the area, we remove the endoscope. If fixation...

Endoforehead Procedure

The endoscopic forehead procedure involves the placement of four incisions in the scalp (Fig. 43.3). The first two incisions are located approximately 2.0 cm on either side of the midline, 1.0-2.0 cm posterior to the hairline. For patients with excessively long foreheads (more than 8 cm), these paramedian incisions are placed directly at the hairline. It is important to keep the forehead incisions as anterior as possible. Otherwise, visualization and dissection in the glabellar region will be compromised. The next set of incisions is located in the temple region, bilaterally, 2.0 cm posterior to the hairline. The incisions should be directed parallel to the hair follicles to prevent unnecessary alopecia, postoperatively. Each incision should measure 1.5 cm in length.

Forehead and Midface Videoendoscopic Surgery

Child Lolicon

Counterindications are previous craniotomy or frontal sinus or bone fracture. Complications include relapse, asymmetry, dysesthesia, paresis, hematomas, burns and alopecia. Many authors studied fixation techniques in endo-scopic surgery, over a long-term period. McKinney 19 and Daniel 4 used central and temporal fixation with screws however, McKinney 20 uses lateral fixation with galea sutures to the deep temporal fascia and bony fixation in parasagittal incisions. He believes that such maneuvers decrease risks of sagittal sinus and middle meningeal artery damage, alopecia and allow a longer esthetic outcome. Jones 9 compared the use of cortical tunnel suture fixation with fibrin glue. He found sutures were a better method of fixation. De Cordier 5 makes three triangular pre-capillary incisions that are sutured in a transverse fashion creating additional elevation besides the temporary sutures in the incisions 5 cm posterior to the hairline, kept in place for 3-5 days. Casagrande 1...

Plane of Undermining and Incision Lines

Surgical Scar Healing Stages

Avoiding hairline distortion is a must in modern facial rejuvenation surgery. A facial aesthetic surgery creating a juvenile contour of the jawline but leaving a zone of baldness in the temporal hair is conterpro-ductive The hairline should be respected as an aesthetic unit of the face. Fullness of the hairline is a sign of youth (Fig. 44.11) a receding hairline with baldness of the sideburn area-as pointed out by Connell 5 - is a sign of aging and should not be produced by using

Anabolic Androgenic Steroids

Anabolic-androgenic steroids have the same effect on the brain as natural testosterone. Thus, when steroid levels are high, the brain and pituitary gland stop producing the hormones that stimulate sperm production and testosterone secretion. In men, this leads to atrophy of the testes, impotence (inability to achieve or maintain an erection), low sperm count, and infertility. Ironically, anabolic-androgenic steroids have feminizing effects on men and masculinizing effects on women. Men may develop enlarged breasts (gynecomastia), while in some female users the breasts and uterus atrophy, the clitoris enlarges, and ovulation and menstruation become irregular. Female users may develop excessive facial and body hair and a deeper voice, and both sexes show an increased tendency toward baldness.

Ispinesib and related compounds

Cell Cycle Everolimus

Ispinesib (SB-715992 CK0238273, 2), one member of a KSP inhibitor series bearing a quinazolinone core, was the first mitotic kinesin inhibitor to enter clinical trials. Like its earlier reported analog 1, ispinesib was reported to be an allosteric inhibitor of KSP that binds at the motor domain and inhibits its ATPase activity in an ATP uncompetitive manner. It was also shown to be > 70,000-fold selective for KSP versus other members of the kinesin family. Results have been reported from two Phase I clinical trials with different dosing schedules. In trial KSP10001 11 , ispinesib was dosed i.v. once every 21 days (q21) in 45 patients. The drug was well tolerated without alopecia or prevalent neurotoxicity. At a dose of 21 mg m2, dose-limiting toxicities (DLT) were prolonged (> 5 days) neutropenia and febrile A second KSP inhibitor, SB-743921, entered clinical trials in 2004. Like ispinesib, it has been shown to be a very selective KSP inhibitor that is > 40,000-fold more...

Non Chromosomal Syndromes Associations and Sequences

Eec Syndrom Foto

In the ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome there are varying manifestations of lobster-claw deformity (ectrodactyly) of the hands and feet and there is cleft lip palate. The cleft lip is usually bilateral. Other manifestations include absence of the lacrimal puncta with tearing and blepharitis abnormal teeth malformations of the genitourinary (GU) tract such as cryptorchidism and alterations in the skin and hair. Scalp hair, eyelashes and eyebrows are usually sparse and hair color is light. The nails may be hypoplastic and brittle. Most of these infants have normal intelligence. In this infant note the severe bilateral cleft lip and palate. Figure 3.20. In the ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome there are varying manifestations of lobster-claw deformity (ectrodactyly) of the hands and feet and there is cleft lip palate. The cleft lip is usually bilateral. Other manifestations include absence of the lacrimal puncta with tearing...

Szary syndrome

Sezary syndrome is characterized clinically by pruritic erythroderma, generalized lymphadenopathy and the presence of circulating malignant T lymphocytes (Sezary cells) 1-3 . Other typical cutaneous changes include palmoplantar hyperkeratosis, alopecia and onychodystrophy 4 . Differentiation from non-neoplastic erythroderma may be extremely difficult. The main causes of erythroderma, besides cutaneous T-cell lymphoma, are atopic dermatitis, psoriasis and drug reactions 5 . Erythrodermic mycosis fungoides should be distinguished from true Sezary syndrome (see Chapter 2).

Hairs Hair Follicles And Sensory Receptors

''I'm worried about going bald '' some of you might complain. ''My dad was bald by the time he was 40 '' ''Oh, I'm sorry '' Professor Joe may respond to your understandable dismay. ''I can see why you are worried about suffering from fox mange (MAYNJ).'' Although it seems strange, humans who go bald are, much like foxes who lose much of their hair, suffering from alopecia (al-oh-PEA-she-ah), which is Greek for ''fox mange'' The problem with alopecia (baldness or ''fox mange'') appears to be a Breaking of the Normal Pattern of Biological Order involved in hair shedding and re-growth on the scalp. This pattern can be broken for a variety of reasons, but most important are inherited genetic (jeh-NET-ik) factors that ''pertain to'' (-ic) the ''genes'' (genet) involved in the hair growth cycle. These hair growth genes apparently turn off or inhibit the re-growth of normal-sized hairs within the follicles, after they are shed. Instead, the affected person re-grows slender ''peach fuzz''...

The Sebaceous Gland Is a Steroidogenic Tissue

The skin and sebaceous glands are capable of synthesizing cholesterol de novo from acetate (22-24). Although this cholesterol is utilized in cell membranes, in the formation of the epidermal barrier, and is secreted in sebum, its use as a substrate for steroid hormone synthesis had not been established until recently. In order for steroid synthesis to occur, cholesterol needs to be translocated from the outer to the inner mitochondrial membrane. This process is regulated by the steroidogenic acute regulatory protein (25). Additional enzymes and cofactors needed to convert cholesterol into a steroid include P450 cholesterol side chain cleavage, adrenodoxin reductase, cytochrome P450c17, and steroidogenic factor-1. Expression of each of these proteins was found in human facial skin, sebocytes, and in a recently developed simian virus (SV) 40-immortalized human sebocyte cell line (SEB-1) (26). These data demonstrate that the skin is in fact a steroidogenic tissue. The clinical...

Medical History and Physical Examination in Patients With Possible Androgen Excess

Polycystic Appearing Ovaries

The timing and pace of pubertal development and its relation to complaints of unwanted hair growth, hair loss, acne, and or obesity should be established. The onset and progression of these complaints should also be established. Drug or medication use and exposure or use of skin irritants should be elicited. A detailed menstrual history should be obtained, with an emphasis on determining whether evidence of ovulatory function (e.g., premenstrual molimina) is present. Change in skin pigmentation or texture, extremity or head size, and changes in facial contour should be noted. A detailed family history of endocrine, reproductive, or metabolic disorders should be obtained. A family history of similar hyperandrogenic signs and symptoms is a powerful clue to the inherited basis of the disorder, although a familial association can be noted for PCOS, HAIR-AN syndrome, NCAH, and IH patients. Clinicians should note that the etiology of hirsutism can often be suspected from the history alone....

Haemorrhagic Fever Viruses

Common clinical features are fever, headache, haemorrhages in the skin and mucous membranes. Case fatality rate is particularly high in secondary attacks of dengue, apparently due to immunological mechanisms. Deafness, hair loss and psychomotor disturbances are frequently recorded sequelae in Omsk haemorrhagic fever.

Parkinsonism Owing To Toxin Exposure

Several studies have explored the role of various environmental causes of parkinsonism, especially exposure to industrial toxins, organic solvents, pesticides, and other putative toxins (35,36). Population studies have shown a link between risk of PD, and chronic (more than 20 yr) exposure to manganese, lead-copper combinations, and iron-copper (37). Mercury exposure has also been linked to PD, but no firm evidence exists for mercury-induced parkinsonism. In the case-control study from Singapore, scalp hair mercury level has been shown to be a poor predictor of risk of PD (38).

Mycosis fungoides with follicular mucinosis follicular pilotropic mycosis fungoides

Mycosis Fungoides Itching

Some patients with mycosis fungoides present with follicular papules and plaques characterized histopathologically by abundant deposits of mucin within hair follicles that are surrounded by a more or less dense infiltrate of T lymphocytes (Figs 2.43 & 2.44) 77 . The hair follicles are infiltrated by the lymphocytes (pilotropism). The epidermis between affected follicles may be spared or involved by the disease ('epidermal mucinosis') (Fig. 2.45). Alopecia resulting from destruction of the follicles is common (alopecia mucinosa), either generalized or localized (Fig. 2.46). Itching is severe and represents a major problem in this variant of mycosis fungoides, and may be non-responsive to standard treatments. Fig. 2.46 Mycosis fungoides with follicular mucinosis. Note partial loss of hairs within the affected skin ('alopecia mucinosa') and superficial erosions representing scratch artefacts resulting from intense itching. Fig. 2.46 Mycosis fungoides with follicular mucinosis. Note...

Hormonal Lifting

The administration of somatotropine can biochemically decelerate the processes of ageing fat cells are reduced and muscle cells are stimulated. Such cures can cost a fortune, however j 10,000-15,000 (US 12,000-18,000) per year. Sex hormones are glorified as true beauty elixirs. Oestrogen promotes hydronic acid, collagen, and elastine fibres and combats free radicals, osteoporosis, and hair loss. Testosterone tightens the epidermis and the connective tissue.

Clinical features

Non-specific skin lesions (eczematous patches) may be present for some time before erythroderma develops. The erythroderma is characterized by intense pruritus and scaling (Fig. 3.1). Common clinical signs are the marked hyperkeratosis of the palms and soles, alopecia and onychodystrophy (Fig. 3.2). Large skin folds (groins, axillae) may be spared. Histopathological analysis of peripheral lymph nodes usually shows evidence of involvement, but differentiation from 'dermatopathic lymphadenopathy' may be very difficult.

Postoperative Care

All patients return the day after surgery and are carefully examined. The drain is removed if the output is less than 20 ml. Any sutures appearing unduly tight are snipped and left in situ. This avoids tension alopecia but averts annoying bleeding from the stitch hole. All flaps are carefully inspected. Patients are forbidden to hold a book or magazine in their hands, sit up straight without a headrest or lay supine or on their side without the chin-neck angle being more than 90 for 10 days. These activities all result in inadvertent neck flexion. Patients must rely on a second-party observer to remind them to keep the chin elevated since proprioception of the chin-neck angle is lacking. A good position that insures an open cervi-comental angle is one in which the patient sits with elbows on knees. This posture allows reading, writing, eating, TV watching, etc. Any time compromise of the postauricular flap is noted, and a check should be made to insure that a tight closure has not...

Metabolic Disorders

Acrodermatits enteropathica is a lethal autosomal recessive disorder with clinical symptoms resulting from profound zinc deficiency secondary to an undefined defect in zinc absorption. The condition is characterized by dermatitis, failure to thrive, diarrhea, alopecia, nail dystrophy, severe gastrointestinal disturbances and frequent infections. Dermatitis lesions are vesciculobullous and are distributed in a symmetrical pattern in the acral and perioral regions. Treatment of choice is elemental zinc replacement.

Inhibition In Vivo

The therapeutic regression of primary tumors without toxicity has not been previously documented. In the studies with human AP, aggressive murine primary tumor growth was inhibited by 81-87 at doses of 50 mg kg given subcutaneously every 12 h, seen for the duration of the experiment of 60 d in some studies (8). There was no weight loss, bleeding, hair loss, growth abnormalities, or other toxicity in the treated animals, including those receiving 100 mg kg d, the maximum dose tested, of either human AP derived from elastase cleavage of plasminogen or recombinant human AP (8,15). It should be noted, however, that formal toxicity studies on AP have yet to be reported.

Ovarian Sonography

Clinical experience has indicated that the majority of women with signs of virilization (i.e., mas-culinization of body muscular, severe or extreme male-pattern balding or hirsutism, clitoromegaly, etc.) will have androgen excess. Although rarely a sign of PCOS, virilization can be seen in patients with disorders of severe insulin resistance, androgen-secreting tumors, and androgenic substance abuse. Less clear is the predictive ability of less dramatic signs and symptoms. Although reviewed previously (see Chapter 14), it is still noteworthy to briefly summarize the predictive ability of the various historical and clinical features of androgen excess.

Spironolactone

Oral spironolactone decreases sebum excretion rate by 30 to 50 . Recommended doses are 50 to 100 mg taken with meals (36,37). However, many women with sporadic outbreaks of inflammatory lesions or isolated cysts respond well to 25 mg twice daily and some even respond to just 25 mg a day. These low doses in healthy young women are generally well-tolerated. However, if this drug is used in older women who may have other medical problems, or if higher doses are used for conditions such as hirsutism or androgenetic alopecia, serum electrolytes should be monitored. Side effects of spironolactone include breast tenderness and menstrual irregularities. Additionally, it is important that pregnancy be avoided during treatment with spironolactone due to the potential for abnormalities of the male fetal genitalia such as hypospadias.

Flutamide

Flutamide is a potent nonsteroidal antagonist of the androgen receptor. Although most commonly used to treat prostate cancer, flutamide has been reported to be efficacious in the treatment of acne, hirsutism, and androgenic alopecia (39). It can be given in doses of 250 mg twice daily in combination with an oral contraceptive. Fatal hepatitis has been reported with this drug. Liver function tests should be monitored and serious consideration should be given to the risk benefit ratio of its use in acne (40). Additionally, because it is an antiandrogen, pregnancy issues are a concern.

Finasteride

Finasteride, strictly considered, is not an antiandrogen, in that it does not act at the androgen receptor. It is a competitive inhibitor of the type 2 isoenzyme of 5a-reductase, the enzyme responsible for conversion of testosterone to the more potent dihydrotestosterone. This drug has been approved for treatment of benign prostatic hyperplasia and male pattern baldness.

Progestins

The progestins contained in oral contraceptives include estranges and gonanes, which are derivatives of 19-nortestosterone, cyprotereone acetate, and a novel progestin, drosperinone. Members of the estrane and gonane class of progestins (Table 2) can cross-react with the androgen receptor, which can lead to increased androgenic effects and could aggravate acne, hirsutism, or androgenic alopecia. These progestins can also cause changes in lipid metabolism and can increase serum glucose, leading to glucose intolerance, as well as possibly interfering with the beneficial effect of estrogen on the sex hormone-binding globulin. However, the third generation progestins, including norgestimate, desogestrel, and gesto-dene, are more selective for the progesterone receptor rather than the androgen receptor. The biological relevance of these differences, however, is uncertain. For

Side Effects

As discussed above, thalidomide has been used for the treatment of leprosy, graft versus host disease, rheumatoid arthritis, aphthous ulcers associated with AIDS, and various dermatologic disorders. The side effects of thalidomide have been well documented and they include drowsiness, constipation, peripheral sensory neuropathy, swelling of the limbs, erythema of the limbs, hair loss, fever, rash, and amenorrhea. Dizziness and mood changes occurred in 33-100 of all patients. Other frequent adverse effects are xerostomia, increased appetite, loss of libido, nausea, pruritus, and menstruation abnormalities have been occasionally observed. The most serious of these side effects is peripheral neuropathy. Its incidence has been estimated to be approx 1 in patients treated for lepra reactions (81), 12 in rheumatoid arthritis (65), 22 in prurigo nodularis (66), and 25 in patients with discoid lupus erythematosus (67). Based on electrophysiologic studies the incidence was estimated at 21...

Eyebrow Manoeuvres

Achieving Symmetric Eyebrows

Fig. 32.2. a Dermographic planning to elevate the left eyebrow endoscopically and through T-V-plasty. b Symmetrical eyebrow position 3 weeks later. Slight hair loss will recover after 6 months Fig. 32.2. a Dermographic planning to elevate the left eyebrow endoscopically and through T-V-plasty. b Symmetrical eyebrow position 3 weeks later. Slight hair loss will recover after 6 months

Function of Sebum

In animals, sebum may provide odor it contains pheromones and may also condition the hair. However, in humans, the function of sebum is unclear (5) and it has been speculated that the sebaceous glands are vestigial (20). There is now an increasing body of evidence indicating that the sebaceous gland and the components of sebum play a crucial role in the homeostasis of skin (6). Sebum transports vitamin E, a lipophilic antioxidant, to the skin surface where it may play a key role in protecting skin surface lipids from peroxidation (62). Glycerol, a major component of sebaceous triglycerides, may play a role in maintaining epidermal barrier function, since asebic mice lacking sebum and, therefore, glycerol have a poorly functioning epidermal barrier (63). Other proposed functions include antibacterial, lubrication, and or to provide precursor substrates for epidermal metabolism and synthesis of lipids and or vitamin D (5). In equine follicles, the sebaceous gland and sebum are required...

Functions of Hair

Tufts and patches of hair, sometimes with contrasting colors, are important among mammals in advertising species, age, sex, and individual identity. For the less groomed members of the human species, scalp hair may play a similar role. The indefinitely growing hair of a man's scalp and beard, for example, could provide a striking contrast to a face that is otherwise almost hairless. It creates a badge of recognition instantly visible at a distance.

Syndrome De Turner

Turner Syndrome

The same infant when crying better demonstrates the findings. Note the antimongoloid slant, the prominent nose, and the micrognathia. Infants with this syndrome may have a cleft of the palate, particularly of the soft palate. A finding in many of these infants is a projection of the scalp hair onto the lateral cheek. Figure 3.194. The same infant when crying better demonstrates the findings. Note the antimongoloid slant, the prominent nose, and the micrognathia. Infants with this syndrome may have a cleft of the palate, particularly of the soft palate. A finding in many of these infants is a projection of the scalp hair onto the lateral cheek.

Seborrhea andor Acne

The prevalence of androgen excess among acneic-only patients (excluding patients with hirsut-ism) is less than among hirsute women. In small studies, between 20 and 40 of patients with treatment-resistant acne and without menstrual disturbance, alopecia, or hirsutism are reported to have androgen excess, principally PCOS (30-33). Alternatively, data regarding the predictive ability of seborrhea for androgen excess is lacking. Large populational studies of acneic or hyperseborrheic patients, particularly those without other evidence of hyperandrogenism (e.g., hirsutism), are then still needed to better define this prevalence.

Hirsutism In Abdomen

Hirsute Stomach

Patients with PCOS may present complaining of irregular or unpredictable menstrual cycles, unwanted hair growth, acne or scalp hair loss, or unexplained weight gain or overweight (see Section 2.1.4.). Another frequent presenting complaint of PCOS may be infertility, possibly associated with recurrent first trimester miscarriages. Approximately 30-50 of PCOS patients will complain of infertility at the time they are seen for their first visit (1,2). The development of hyperandrogenism in PCOS is usually associated with a slowly progressive clinical history and stable symptomatology by the mid to late 30s. As patients enter the fourth decade of life, their symptoms may improve, possibly associated with a decline in circulating androgen levels (6). Alternatively, the rapid development of symptoms, including hirsutism, oligo-amenorrhea, severe acne and alopecia, increased muscularity, and clitoromegaly, is indicative of a virilizing syndrome, most commonly caused by an androgen-producing...

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