Why You Should Stop Getting Steroid Shot Injections For CCCA Alopecia (Scarring Alopecia)
alopecia areata universalisBecome A Youth Mentor. Alopecia UK provides information, advice and support for people with experience of alopecia areata, alopecia totalis and alopecia universalis. Alopecia areata, alopecia totalis, alopecia universalis. Authoritative facts about the skin from DermNet New Zealand. Alopecia areata de naam betekent pleksgewijze kaalheid is een sterokds, waarbij een persoon vrij plotseling gedeeltelijk kaal wordt. Deze aandoening kan op …. Alopecia areata is a oral steroids alopecia areata autoimmune aoopecia that results in hair loss on the scalp and any other parts of the body.
Alitretinoin for the treatment of severe chronic hand eczema
Platelet-rich plasma PRP is autologous concentration of platelets contained in small volume of plasma which accelerates the rejuvenation of skin and hair follicles HFs due to presence of various growth factors and cellular adhesion molecules 1.
PRP therapy is a relatively new approach to tissue regeneration which is becoming a valuable adjunct to promote healing during many procedures in various medical and surgical fields, including wound healing, maxillofacial surgery, soft tissue injuries, periodontal and oral surgery, orthopaedic and trauma surgery, otolaryngology, cardiovascular surgery, gastrointestinal surgeries, burns, cosmetic and plastic surgery.
PRP specifically has attracted the attention of dermatologists for management of various alopecias 6. These factors regulate cell migration, proliferation, remodelling of the extracellular matrix ECM and promotion of angiogenesis, creating a beneficial environment for enhanced wound healing 4 , 7.
A bell-shaped response curve indicating a dose dependent nature is associated with PRP 4. Concentrations higher or lower than1.
PRP should be used at the concentrations of five to ten times the mean levels. The platelets actively secrete growth factors within 10 minutes after activation and more than ninety five percent of the presynthesized growth factors are secreted within 1 hour 8 , 9. Therefore, PRP should be used within 10 minutes of activation. The viability of the concentrated platelets remains for up to 8 hours and they stay sterile if placed on a sterile surgical table 3.
The platelets remain viable for 7—10 days and the release of growth factors in the tissue continues during this period Two Vials, each containing Out of these two vials, a total of 5—6 mL of buffy coat along with PRP is harvested and injected as per requirement. It gives 5—7 times the concentration of the baseline platelet count. PRP is a relatively safe procedure. Though minor complications are mentioned as pain in the injected area; headache, heaviness of head, swelling, redness, infection, allergic reaction-urticarial rash, temporary skin discoloration, bruising etc.
The most interesting fact in origin of hair is that it arises from amalgamation of ectodermally derived structures giving rise to follicular unit and sebaceous glands and mesoderm tissues forming dermal papillae DP which gives rise to arrector pili muscle APM and adipocytes. Dermal papilla is made up of specialized fibroblast-like cells embedded in an ECM rich in basement membrane proteins and proteoglycans In the bulge area, primitive stem cells of ectodermal origin are found, which express a number of ECM proteins, one of which is nephronectin with five EGF-like repeats.
During anagen, HF stem cells further divide leading to formation of transient amplifying cells which forms the ORS of lower part of HF and migrate in a downward direction. On entering the hair bulb matrix, they proliferate and differentiate to form hair shaft and IRS and may also form sebaceous glands Reciprocal interactions between epidermal stem cells, dermal papilla cells and epidermal basement membrane are essential for HF formation and maintenance APM arises proximally at the HF at the bulge, which is an epithelial stem cell niche.
The APM bulge connection persists throughout hair growth cycle and plays a vital role in morphogenesis and renewal of HFs. Preservation of APM may be associated with reversible hair loss while loss of attachment between APM and HF may be associated with irreversible or partially reversible hair loss 18 , Considering the role of APM in maintaining follicular integrity, Poblet et al. The hypothesis says that the epidermal stem cells underlying the APM are analogous to pebbles, while ectodermal basement membrane component is like the soil for survival of the follicular unit.
The flower HF can only survive if held by ribbon and surrounded by soil and pebbles. As soon as the nephronectin from the soil i. This might be an explanation for infiltration of fatty tissue in AGA as found by Torkamani et al. Scalp hair complete the body self-image and patients who have alopecia suffer from overt disfiguration, which may cause psychosocial embarrassment and lack of self-esteem Hair loss or alopecia is one of the most common complaints amongst the patients consulting a dermatologist and can be temporary or long lasting Alopecia can be classified into two broad categories—non-cicatricial and cicatricial alopecia.
The causes of non-cicatricial alopecias include androgenetic alopecia, telogen effluvium, alopecia areata, trichotillomania, anagen effluvium etc. Lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans, cutaneous discoid lupus erythematosus etc. Various treatment modalities traditionally exist in the armamentarium of a clinician for management of alopecias. Therapeutic interventions for androgenetic alopecia include topical minoxidil, oral finasteride and dutasteride, peptides and hair transplant surgery High protein diet, iron supplements, exclusion of drugs which induce catagen like beta-blockers, retinoids, anticoagulants, diagnosis and treatment of catagen-inducing endocrine disorders thyroid dysfunction, hyperandrogenism, or hyperprolactinemia help in management of telogen effluvium An adequate evaluation including detailed dietary history and management is essential for appropriate patient care and successful treatment of alopecia Androgenetic alopecia is the most common type of baldness clinically characterized by progressive hair loss.
The frequency of AGA increases with age, even though it may start at puberty 26 , AGA occurs due to HF miniaturization within the follicular units. There is progressive reduction in diameter, pigmentation and length of the hair shaft. The miniaturized hair is the hallmark of AGA Currently, the Hamilton-Norwood classification system for males and the Ludwig system for females are most commonly used for the description of pattern of hair loss Female patterned hair loss FPHL is a non-scarring diffuse alopecia, evolving from the progressive miniaturization of HFs and subsequently leading to reduction of the number of hairs, especially in the central, frontal and parietal scalp regions Multiple compound follicular units comprising a primary follicle and several secondary follicles are present across the scalp.
In early stages of the hair loss, patients usually complain of thinning of hair and a decrease in the pony tail volume, but there is little visible baldness. Miniaturization first occurs in the secondary follicles. The muscle still remains attached to the primary follicle at this stage With progression of the disease, miniaturization continues and the muscle completely loses attachment to the secondary follicles. Later, primary follicles in herald units are also affected by miniaturization, and eventually muscle attachment is lost.
Baldness occurs when the entire follicular unit is miniaturized. Similar pattern of miniaturization and muscle loss continues until all follicular units are affected and there is visible baldness at this stage The interaction between the APM and the follicle mesenchymal might be an essential part of the HF cycle. The DP and dermal sheath include a population of mesenchymal stem cells that contribute to the follicle homeostasis There are two main schools of thoughts in pathogenesis of androgenetic alopecia.
One is the coordinated follicular cycling with movement of cells between the DP and dermal sheath. This process is thought to be disrupted in AGA to cause the loss of cells from the DP and consequent follicle miniaturization. Cells of DP and dermal sheath are capable of undergoing both smooth muscle and adipose differentiation in vitro.
Thus, cells from the follicle mesenchyme may also contribute to the APM maintenance. The muscle degeneration seen in AGA may be caused by the loss of progenitor cell population which is responsible for maintaining both the APM and the DP In their study, Torkamani et al. Muscle volume was decreased and fat volume increased significantly in AGA compared with controls Treatment options for androgenic alopecia are limited and include topical minoxidil and oral finasteride FDA approved alone or in combination.
Several reported side effects such as headache and increase in body hair are there for minoxidil whereas loss of libido has been reported with oral finasteride. Incidence of loss of libido varies from 3. Finasteride also interferes with genital development in male fetus and is contraindicated in pregnant women and those likely to become pregnant PRP has emerged as a new treatment modality in regenerative plastic surgery, and dermatology and increasingly more literature suggests that it might have a beneficial role in hair regrowth Also, as the mechanism of action of PRP is different from other treatments, an additive positive effect may be there on using PRP as an adjuvant to minoxidil and finasteride New hair growth was observed in 6 patients as early as 7 days and in 4 patients in 15 days Moderate improvement in hair volume and coverage was reported There was a significant difference in the yield of follicular units on comparing the experimental and control areas of the scalp Intra-operative PRP therapy just after slitting is beneficial in giving faster density, reducing the catagen loss of transplanted hair, recovering the skin faster and activating dormant follicles in FUE transplant subjects compared to placebo, as noticed by Garg et al.
Detailed video microscopic examination with regular follow ups was done in 10 male and 10 female patients. PRP therapy was given as three sessions repeated after every month.
Parameters which were observed on video-microscopy are hair count, diameter of hair, change in texture, multiplicity of hair, Perifollicular halo, perifollicular pigmentation, increase in telogen hair and increase in vellus hair count.
Interestingly new hair growth was seen as early as 4 weeks in male patients whereas signs of new hair growth were visualized in 6 weeks in females. Though PRP helped in increasing hair count in both groups, but the increase was statistically significant in male group with P value 0.
Other findings were improved hair density, improvement in perifollicular halo and pigmentation, textural improvement of skin and multiplicity of hair in follicular units in female Figure 2 as well as male patients Figure 3. The comparison of median increase in hair count parameters in two groups has been highlighted in Figure 4. Perifollicular pigmentation is thought to be due to dermal infiltrates in AGA Authors propose that visualization of depressed haloes on video microscopy may predict a positive outcome of PRP and reversal of miniaturization as these depressed haloes probably depict fibrosed APMs which are essential for the integrity of HF.
In the published study by author, PRP therapy which was injected during FUE hair transplant in a randomized control manner just after slitting was found to play a significant role in regrowth of dormant hair, reduction in scalp redness, decrease in catagen hair loss and remarkably improved density and quality of hair growth after the FUE transplantation It was also shown that adding activated platelet-rich or platelet poor plasma promoted the proliferation of human adipose-derived stem cells and human dermal fibroblast significantly in the cell culture Diverse group of cells, such as endothelial cells and keratinocytes, produce platelet derived growth factor PDGF , which is fundamental for cell growth and proliferation.
PDGF induces and maintains anagen phase in mouse hair cycling. PDGF signals are involved in both epidermis-follicle interaction and the dermal mesenchymal interaction required for hair canal formation and the growth of dermal mesenchyme 4. VEGF seems to be a major mediator of HF growth and cycling thereby, providing direct evidence that improved follicle revascularization promotes hair growth PRP injections improve cutaneous ischemic conditions and increase vascular structures around HFs Basic fibroblast growth factor b FGF promotes the proliferation of cells of papilla in vitro, and therefore, plays a key role in hair shaft elongation Administration of BMP protein causes the competent region to become refractory.
Activated PRP also increases levels of the anti-apoptotic protein Bcl-2, thereby preventing apoptosis. PRP was used as mesotherapy by Greco et al. A double-blinded, placebo and active-controlled, half-head, parallel group study on 45 patients to evaluate the efficacy of PRP in Alopecia areata concluded that PRP is a safe and alternative treatment for AA.
PRP was found to significantly increase hair regrowth, decrease hair dystrophy and burning or itching sensation without much side effects There were no side effects and procedure was well tolerated Donovan concluded that PRP therapy has potential to treat steroid-resistant forms of AA including ophiasis type and that PRP can be an option to treat AA patients who develop limiting side effects from steroid injections El Taieb et al.
Alitretinoin for the treatment of severe chronic hand eczema
The treatment of Alopecia areata is different from other types of hair loss. disease is by corticosteroids either applied as local injections or oral corticosteroids. Oral steroid therapy for subfertile males with antisperm antibodies in the die androgenetische Alopezie und die Alopecia areata gefunden, da man hoffte durch. die Alopecia areata universalis (etwa 1 % aller Alopecia- areata-Fälle) durch ein Fehlen . steroidinduzierten Follikulitis ist bei bestimmungsgemäßer. Anwendung . orale Zinksubstitution empfohlen über einen Zeitraum von 3–6 Monaten.