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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 here...

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Pattern Baldness In 3 Generatiins Of Addams Family

Puberty Hen

I 5.12 Pattern baldness is a sex-influenced trait. This trait is seen in three generations of the Adams family (a) John Adams (1735-1826), the second president of the United States, was father to (b) John Quincy Adams (1767-1848), who was father to (c) Charles Francis Adams (1807-1886). Pattern baldness results from an autosomal gene that is thought to be dominant in males and recessive in females. (Part (a) National Museum of American Art, Washington, D.C. Art Resource, NY (b) National Portrait Gallery, Washington, D.C. Art Resource, N.Y. (c) Bettmann Corbis.) An example of a sex-influenced characteristic in humans is pattern baldness, in which hair is lost prematurely from the front and the top of the head ( FIGURE 5.12). Pattern baldness is an autosomal character believed to be dominant in males and recessive in females, just like beards in goats. Contrary to a popular misconception, a man does not inherit pattern baldness from his mother's side of the family (which would be the...

Another Sex Influenced Trait Male Pattern Baldness

A more dramatic example of a sex-influenced trait is male pattern baldness. Because mostly men are affected, one might guess that it is a sex-linked trait. A classic case of male pattern baldness appears in President Adams's family. The second U.S. president, John Adams, and his son John Quincy Adams, the sixth president, as well as the latter's son and grandson, all had male pattern baldness. If this trait was on the X chromosome, as figure 3.2 shows, a father could not pass the trait onto his sons, meaning they must have received the trait from their mothers. However, it would be quite a coincidence if all four of the mothers of the individuals listed above were carriers of male pattern baldness. Actually, male pattern baldness is also a sex-influenced trait. The difference in the appearance of the trait is due to the hormonal differences between men and women. Thus in men the trait behaves as a dominant trait, while in women it behaves as a recessive trait.


A RCT of scalp massage using thyme, rosemary, lavender and cedarwood essential oils in 86 patients with alopecia areata found a significant improvement in hair growth after 7 months (Hay et al 1998). Although the efficacy of lavender as a stand-alone treatment was not clarified with this trial, it is known that the herb has some antibacterial and antifungal activity that may play a role. In a single case study, topical application of lavender, together with other essential oils, was reported to assist in treating scalp eczema (De Valois 2004).

Effect Does Not Equal Effect

The severity of the disease and dose. These nonstochastic effects occur mainly in radiation therapy. In interventional radiology and neuroradiology such as cardiovascular stenting or percutaneous treatment of complex arteriovenous malformations in the CNS, nonstochastic effects such as radiation-induced erythema, ulcerations, or hair loss have been reported anecdotally in patients undergoing complex procedures exposed to prolonged fluoro-scopy, for example. Obviously this also poses a serious threat to the physicians involved. Radiation-induced lens injury has been reported in interventional radiology.

Adjuvant Therapy For The Individual Patient

Adjuvant therapies now available and currently being investigated have been described in this chapter. For the individual patient assessed in the clinic, a decision must be made by the multidisciplinary team as to whether the patient is fit to receive any of these therapies. All treatments administered are likely to induce some toxic reaction, and these must be weighed against the benefits likely to be achieved. The different regimes with different drugs have their own individual side-effect profiles. These have been detailed in this text and in Chapter 17 when the drugs have been discussed in the metastatic colorectal setting. The risks of infection and thrombophlebitis associated with prolonged venous access, and the likelihood of inducing neutropenic incidents, as well as risks of other physical harm, must be assessed by the physician and presented to the patient. Patients would also have their own views as to which side effects are acceptable to them. Some may find the alopecia...

Significance to humans

Insectivores are secretive, nocturnal, shy, and for most humans fall into neither the cute and cuddly nor the big and scary attention-generating categories. A few individual insectivore species, however, have been singled out for attention. The greater hedgehog tenrec (Setifer setosus), for example, is probably the most recognizable of the insectivores. This creature is easy to keep as a pet and has a large enthusiastic following. Hedgehogs are also important in research on diseases such as foot and mouth disease, yellow fever, and influenza. Old home remedies sometimes called for hedgehog blood, entrails or ashes. Mixed with pitch or resin, the burned hindquarters supposedly helped cure baldness. The hedgehog was used to predict the weather and if buried under a building was thought to bring good luck. The Romans kept hedgehogs as pets during the fourth century B.C. and they remain domesticated to this day. Other uses over the years for this spiny insectivore include consumption of...

Complications Of Radiosurgery

It is true that there are almost no immediate complications of radiosurgery, but complications do occur. Such problems include small patches of alopecia for tumors adjacent to the scalp, brain edema, radiation necrosis, neurological deficits, and failure to achieve the intended goal. The risk of complications is a function of the tissue volume being treated, the dose delivered, the location, and prior radiation treatments.

Legal Attempts To Regulate Biotechnology And Assign Ownership

How has patent law managed to be seen under western law as neutral and somehow removed from cultural or ethical considerations Historically the subject matter of patents, inventions, have been associated with science as positive, objective and progressive. Clearly this has coloured the view that patent law is merely the body of apolitical technical rules to which Recital 23 refers. The question of patenting genetic information, particularly that of humans, has brought ethical concerns into the debate, but salient matters have still to be resolved. For instance, while Article 53(a) of the European Patent Convention states that patents are not to be granted for inventions, the publication of which would be contrary to ordre public or morality, the European Patent Office traditionally decides issues under this section in a utilitarian risk benefit balancing act, an approach which is explicitly endorsed in Recital 21. In practice, cases involving genetic modification tend to be decided...

Side Effects Of Radiotherapy Acute Reactions

Desquamation and some degree of erythema, which are managed with local ointments. Temporary alopecia within the radiation field is a common sequela. Fatigue may be observed with radiation therapy, but is often a function of several other variables such as age, performance status, underlying medical status, and extent of brain being irradiated.

Dissecting Folliculitis of the Scalp

Clinically, dissecting folliculitis of the scalp is characterized by peri-follicular pustules, nodules, abscesses and sinus that progressively evolve into scarring alopecia. The clinical picture is often complicated by a keloid tendency 4, 9, 15, 23 . The course of the disease is chronic and relapsing. Squamous cell carcinoma may arise in chronic relapsing lesions and has a recognized metastasizing potential. Death from metastatic carcinoma has been described in one patient 9 .

Future Lines of Research

Future research using the bat as a model for the study of aging may reveal mechanisms that confer resistance to expected senescent processes observed in other long-lived mammals. Elucidation of the physiological mechanisms that give rise to the exceptional longevity observed in bats may provide insight into the development of novel treatments and therapies of degenerative diseases associated with senescence in humans. Chien and Karsenty (2005) describe the typical manifestation of the aging phenotype in long-lived mammals as development of osteoporosis, reduction in body weight, lean-reduced fat tissue, loss of hair or alopecia, cardiomyopathy, early loss of fertility in females, anemia with extramedullary hematopoiesis, reduction in physical activity, and lack of obvious cause of death. Following is a brief review of potentially heuristic lines of research using the bat as a model for the study of aging.

Hair Follicles And Hair

Surfaces of the hands, sides and plantar surfaces of the feet, the lips, and the region around the urogenital orifices. Hair distribution is influenced to a considerable degree by sex hormones these include, in the male, the thick, pigmented facial hairs that begin to grow at puberty and the pubic and axillary hair that develops at puberty in both genders. In the male, the hairline tends to recede with age, and in both genders, the scalp hair thins with age because of reduced secretion of estrogen and estrogenlike hormones.

Mycosis Fungoides And Sezary Syndrome

SS is generally regarded as the leukemic form of epidermotropic cutaneous T-cell lymphoma (MF). Clinically, SS is characterized by erythroderma, palmoplantar keratoderma, partial alopecia, lymphadenopathy, and pruritis. Atypical lymphocytes are seen in the blood and take the form of lymphocytes with grooved, cerebriform nuclei of large (typical Sezary cells,) or small (so-called Lutzner cells) size. Although originally described in 1961 by Tasell and Winkelmann,49 the exact definition of SS is still not uniformly agreed upon. Disagreement revolves around both clinical issues and laboratory issues. Clinically, distinction is made by some authors between classical SS, in which patients develop signs and symptoms over a rapid period of time usually without a prior history of

And Antiandrogen Therapies

CPA is a progestin with several antiandrogenic activities binding to AR, inhibition of androgen metabolism and antigonadotropic activity. CPA has been used extensively in Europe for 30 years in the treatment of hirsutism. It can be given according to various regimens (usually 50 mg daily on days 1-20 of each menstrual cycle, but other regimens are possible with CPA of 50 or 100 mg) together with natural E2 or with an OC pill. Good results may be obtained in hirsutism and also in women with severe and or persistent acne or with androgenic alopecia. Side-effects are uncommon and the anti-androgen is well tolerated 6, 11, 17, 18 . Spironolactone is the most generally used anti-androgen in countries where CPA has not been approved. Spironolactone binds to AR but is devoid of antigonadotropic activity. Doses needed for antiandrogenic efficacy are 75-200 mg daily depending upon the indication (acne, alopecia or hirsutism). Concomitant use of OC or a non-androgenic progestin can prevent...

Prospective Dose Intensity Trials for Breast Cancer

Mg mL, methotrexate 40 mg mL, 5-fluorouracil 600 mg mL) and low dose (cyclophosphamide 300 mg mL, methotrexate 20 mg mL, 5-fluorouracil 300 mg mL). Response rates were higher for the standard-dose cohort (30 vs 11 , p 0.3), but there was no statistical difference in overall survival (15.6 mo vs 12.8 mo, p 0.12). Although the rates of toxicity (vomiting, alopecia, myelosuppression, and conjunctivitis) were higher in the standard-dose cohort, patients in the standard-dose cohort had an improved quality of life. Based on the increased response rate, trend to improved survival, and overall improvement in quality of life, the authors concluded that the rate of disease palliation was improved with higher dose therapy.

Initiation Of Dopamine Agonist Therapy

Dopaminergic medications have similar side effect profiles nausea, sleepiness, confusion, orthostatic hypotension, and hallucinations among others (Table 2). Besides these problems, lower extremity edema, hair loss, and weight gain have also been seen with dopamine agonist use. The ergoline-derivatives, bromocriptine, cabergoline, and pergolide, also have a slight risk of erythromelalgia and pulmonary and retroperitoneal fibrosis, which have been reported in 2 to 5 of patients exposed to these agents (1). With all dopaminergic agents, it is possible that excessive daytime sleepiness, unexpected sleep episodes, and reduced impulse control leading to behaviors such as pathological gambling could occur in a small percentage of patients (34-39). Therefore, patients should be educated to be vigilant of these potential side effects and notify their physician if they occur. The side effects of these agents are quite similar, but vary from patient to patient, so it is important for a patient...

The Structure and Properties of Hair

4-month resting stage (telogen) during which the old hair is shed. With the onset of the anagen, the new hair starts to grow from the same follicle. The growth process functions independently in each follicle, so hairs are not shed simultaneously as they are in most animals. At any given time, some hairs are growing, some are resting, and some are being shed. Normally, of about 150,000 scalp hairs, 90 are in the anagen phase and the remaining 10 are in the catagen and telogen phases, with 50 to 100 hairs being shed daily. Scalp hair is a fiber of 50-80 m in diameter and its exterior consists of a layer of flat, imbricated cuticle cells pointing outward from root to tip. This ratched-like structure of the cuticle scales serves as an effective self-cleaning feature and, by interlocking with the scales of the inner root sheath of the follicle, helps to hold the hair firmly in place. The cuticles are thin (0.5 im), 50 to 60 im square sheets, attached at their approximal ends to the...

T187m R227q F234l F194l

Several other androgen-signaling genes have been preliminarily studied in the context of prostate cancer risk. Testosterone is synthesized from cholesterol in a series of enzymatic steps involving several of the cytochrome P-450 enzymes.64 The enzyme cytochrome P-450c17 catalyzes two sequential reactions of the biosynthesis of T, in both the gonads and the adrenals. The first step is the conversion of pregnenolone to 17-hydroxypregnenolone (hydroxylase activity), and the second is its subsequent conversion to C19 steroid dehydroepiandrosterone (lyase activity), a steroid with androgenic activity.64 The CYP17 gene on chromosome 10 encodes the P-450c17 enzyme involved in these two sequential reactions in T biosynthesis.65 A T-to-C transition SNP exists in the 5'-UTR of the CYP17 gene (A2 allele).66 While the functional relevance of this polymorphism is in dispute, it has been linked to polycystic ovarian cancer risk in women, male pattern baldness in men,66 various estrogen metabolic...

Quasidrugs In The Future

Generally, topically applied quasidrugs are intended to mollify unwanted aspects of the skin and have a mild action on the human body, whereas medical drugs are intended to treat specific diseases. Therefore, hair-growth products with a mild action on male-pattern baldness, which is not a disease 2 , are quasidrugs. On the other hand, products intended for alopecia areata, which is a disease, are regarded as drugs. The natural aging of skin, like wrinkling, is not a disease, for example. We should also keep in mind that ''high efficacy'' should not always involve ''strong action.'' There will be many pseudo-drugs or cosmeceutical products with mild actions showing good efficacy.

Clinical Experience Etretinate and Acitretin for HS

Sion 3 months after stopping etretinate 37 . Scheman 38 treated a 41-year-old man, who presented with severe nodulocystic facial acne and HS on the inguinal folds, with acitretin (0.6 mg kg per day). After 2 months, the patient's HS was completely controlled, and his very severe acne improved to only a few inflamed nondraining facial cysts. With a dosage of acitretin of 0.9 mg kg per day the patient was completely free of inflammatory lesions on his face and groin. After 4 months on this dosage, however, alopecia and unacceptable joint pain developed. After 1 month off acitretin, the patient's side-effects resolved. Treatment was resumed back at a dose of 0.6 mg kg per day, with results similar to those when the patient was previously on this dosage. After 5 months of therapy, improvement continued to be satisfactory 38 .

Allergic Reactions And Other Toxicities

One of the most common acute side effects of germ cell tumor treatment is alopecia. The principal agents that cause alopecia are etoposide, ifosfamide, and paclitaxel only WHO grade I hair loss is associated with cisplatin, vinblastine, and bleomycin, as single agents. With combination chemotherapy, used predominantly for treating this disease, the majority of patients will suffer significant alopecia.1315,50

Biological Functions of Shps

The phenotypes of me me and mev mev mice differ only in severity, with me me mice succumbing to abnormalities earlier (2-3 weeks) than mev mev (9-12 weeks) 93-98 . For this reason, we use me to refer generically to Shp1-deficient mice. The me phenotype derives its name from patchy hair loss, which gives the mice a motheaten appearance. The hair loss, in turn, results from sterile dermal abscesses consisting of neu-trophils. Inflammation also is prominent elsewhere, including the joints, liver, and lungs. The latter leads to the early demise of me mice, due to severe interstitial pneumonitis caused by

Clinical Manifestations

NME is the hallmark finding in glucagonoma syndrome. It is characterized by a polymorphous eruption that most commonly presents as scaly, erythematous papules and plaques with superficial erosions. The lesions typically are in a perioral distribution on the face (Fig. 9), but also involve the perineum, lower abdomen, thighs, buttocks, and less commonly the distal extremities. NME has been reported to be the presenting complaint in approximately two-thirds of patients with this tumor, but there are only rare cases of glucagonoma without NME ever occurring. Stomatitis, glossitis, dystrophic nails, and alopecia can also be seen. The eruption is frequently misdiagnosed as seborrheic dermatitis or intertrigo and can also resemble pemphigus foliaceus, acrodermatitis enteropathica, chronic mucocutaneous candidiasis, or psoriasis.

Surgical Pathology Specimens Laboratory Protocols

Punch Biopsy Alopecia

Punch biopsy for alopecia punch biopsies are taken to establish the cause of alopecia and are embedded in the usual manner. In some centres, depending on the experience of the dermatopathologist, the punch biopsy may be bisected, with one half embedded and sectioned in the usual vertical fashion and the other half sectioned transversely. This is thought to give a better view of the hair follicle structures and assist in the diagnosis of alopecia (Figure 37.3). Figure 37.3. Vertical and horizontal sections of a punch biopsy for the diagnosis of alopecia.

Care Of Captive Bat Populations

It is important to keep a systematic record of the health condition of every bat in a captive colony. Individuals should be weighed regularly to assess for weight loss, which may be a sign of illness, as well as hyperphagia, though it is important to remember that hibernating bats will gain weight in preparation for hibernation. Other clinical signs to assess include diarrhea, vomiting, loss of pigmentation and or dryness of the skin, hair loss, and lethargy. Several of the books listed in the Recommended Resources section of this chapter have helpful information on diagnosing common medical conditions.

Scalp and Facial Hair Patterning

Hair directional slope is secondary to the plane of stretch exerted on the skin by the growth of underlying tissues during the period of down-growth of the hair follicles at around 10-12 weeks gestation. The posterior parietal hair whorl is interpreted as the focal point from which the growth stretch is exerted by the dome-like out-growth of the brain during the time of hair follicle development. Malformations that antedate hair follicle development, such as encephalocele, produce aberrations in scalp patterning. Eighty-five percent of patients with primary microcephaly have altered scalp hair patterning, indicating an early onset of abnormal brain development. Aberrant scalp patterning is also found frequently in association with established syndromes including Down syndrome. Thus, aberrant scalp hair patterning may be utilized as an indicator of altered size and or shape of the brain prior to 12 weeks gestation. Early anomalies in development of the eye and of the face can...

Gender Effects on Phenotype

Example, a gene for hair growth pattern has two alleles, one that produces hair all over the head and another that causes pattern baldness (fig. 24.13). The baldness allele is dominant in males but recessive in females, which is why more men than women are bald. A heterozygous male is bald, but a heterozygous female is not. A bald woman would have two mutant alleles.

IL1 Receptors in the Skin

Mation, such as inflammatory bowel diseases, alopecia areata, psoriasis, lichen sclerosus or lupus erythematosus, IL1RN*2 homozygosity increases the severity of the inflammation, suggesting that persons with this allele have a more prolonged and more severe proinflammatory immune response than do persons with other IL-1RA genotypes 73 . Interestingly, the frequency of the two-repeat allele of IL-1RN is increased among patients with acne conglobata but not among those with HS. In addition, IL1RN*2 homozygosity was detected only amongst patients with severe acne conglobata, suggesting that allele 2 of the IL-1RN gene may contribute to the development of acne conglo-bata but not HS 38 .

Antiandrogenic Progestins

Other progestins with antiandrogen properties 11, 14 (antagonists at the AR levels) include chlormadinone acetate (CMA), drospirenone and dienogest. They may be used either in combination with EE 5, 8, 16 as a contraceptive OC (similarly the combination of CPA 2mg + 30 g EE) or as antiandrogenic progestin alone (CMA for instance) according to countries where the drugs have been approved. In fact no evaluation of the effects of these progestins exists in women with hirsutism, severe acne or chronic alopecia.

Psychosocial Factors Involved In Hair Cosmetics

Hair is midway between nature and culture 1 . Haircare attitudes are different from one society to another regardless of economic differences, and from one person to another within societies e.g., hair loss is not equally perceived by everybody in all societies in the same manner 2-5 . Some people are seriously psychologically affected and ready to spend a fortune in order to cope with the problem, whereas others just do not care at all. In the former group, styling is of high significance as is the selection of cosmetic agents.

Measure of Quality of Life Quantitative Approach

A quantitative approach for measuring QoL in HS was performed 2 . Questionnaires widely used in other skin diseases such as the Dermatology Life Quality Index (DLQI) questionnaire, Skindex and VQ-Dermato 1, 4, 5 were chosen. This approach allows a direct comparison of the results with those from previous studies on other skin diseases. We will discuss two studies, one already published and our unpublished data 2 . In both studies, in addition to this questionnaire, basic demographic data and aspects of the history of HS were collected 114 patients participated in the first one 2 and 61 in the second. In the study of der Werth and Jemec 2 the recorded mean DLQI score was 8.9, higher than scores found in several other dermatological conditions such as alopecia, acne, psoriasis, Hailey-Hailey disease, vascular anomalies of face, and atopic dermatitis. In our center (unpublished data) using two other skin-disease-specific QoL questionnaires (Skindex and VQ-Dermato) 1, 5 , the scores...

Testimony on the Anabolic Steroid Control Act of 2004

The perils of anabolic steroid use are well known. In Olympic sport, the most notable, systematic state-supported program of doping with anabolic steroids was conducted by the East Germans from 1974 until the Berlin Wall fell. One of the anabolic substances developed by the East Germans as part of their doping program was androstenedione. In the body, androstenedione metabolizes into the anabolic steroid, testosterone. The documented side effects of the East German steroid program, particularly for women athletes, were tragic. These side effects include damage to the liver and reproductive system, susceptibility to cancers, and permanent masculinization of women. It is also well known that men who abuse steroids and steroid precursors risk serious health consequences including gynecomastia, baldness, shrunken testicles, infertility and susceptibility to aggressive behavior or rage. For adolescents who use steroids the side effects can include all of the above, as well as a strong...

Radiation Oncology Nurse

Radiation therapy provides an important role in the management of HGG. Nursing care provided by the radiation oncology nurse begins at the initial consult visit and continues into the early post-radiation phase. Patients and families must be educated regarding treatment schedules and expected effects and side effects. Options available to patients include conventional regional radiation, whole brain radiation, stereotactic radiosurgery such as gamma knife or photon beam, brachytherapy, and hyperthermia (31). It is often difficult to assess if symptoms are being caused by the radiation therapy itself, tumor growth, or other concurrent therapies. Acute symptoms occur within the first few weeks to months and are usually self-limiting. These include nausea but rarely vomiting, anorexia, impaired taste, fatigue, increased seizures, increased neurologic deficits, skin changes, hair loss, and impaired wound healing. Some patients whose radiation fields lie near the ear can experience hearing...


Possible associations with androgen levels have been explored, using proxies. Two presumed proxies for testosterone levels are a history of severe acne during puberty and male pattern baldness as both are associated with somewhat higher testosterone levels. A history of both conditions may be less frequent among men who develop testicular cancer.84 In addition, testicular germ cell tumors and CIS are observed in patients who are in a low-androgen state.89 While animal experiments show that androgen is required for testicular descent,90 a limited number of epidemiologic studies suggest that a high proportion of boys with cryptorchidism have normal androgen action and response.91,92 Some cases of hypospadias have been attributed to defects of androgen action or response, but this mechanism appears to account for only a small proportion of

Hormonal Treatment

Contraindications to testosterone therapy include androgenic alopecia, seborrhea, or acne, hirsutism as well as a history of polycystic ovary syndrome, and estrogen depletion. Oral methyl testosterone therapy is contraindicated in women with hyperlipidemia or liver dysfunction. Regular follow up is both clinical inspection of skin and hair for seborrhea, acne, hirsutism, and alopecia and biochemical through monitoring of free bioavailable testosterone and SHBG, keeping these values within the normal range for premenopausal women. Of note, methyl-T is not included in the usual assays for T. Possibly, the target level for older women should be even lower but this remains unclear. Lipid profile and glucose tolerance are also monitored. The current recommendation is to prescribe only for 12 months owing to lack of long-term safety data (92).


Patients suspected of having bulimia nervosa should be given a complete physical examination because the disorder has so many potential medical complications. In addition, most bulimics are close to normal weight or only slightly overweight, and so do not look outwardly different from most people of their sex in their age group. The examination should include not only vital signs and an assessment of the patient's height and weight relative to age, but also checking for such signs of bulimia as general hair loss, abdominal soreness, swelling of the parotid glands, telltale scars on the back of the hand, petechiae, edema, and teeth that look ragged or moth-eaten.


Irinotecan is similarly being developed for adjuvant use, having been shown to be active in metastatic colorectal disease both alone and in combination with 5-FU. It is a topoisomerase I inhibitor. (This enzyme is involved in DNA supercoiling.) The advantage over oxaliplatin is a relative lack of long-term side effects, although short-term side effects include diarrhea, myelo-suppression, and alopecia.

Brain Metastases

More than 100,000 patients are diagnosed with brain metastasis annually. The management of brain metastasis patients remains a challenge for oncologists, radiation oncologists, and neurosurgeons. Traditional therapy of single metastasis has been either resection or whole brain radiation (WBRT), with a boost to the affected region, or combined surgery with whole brain radiation. The surgical resection of solitary metastasis with WBRT has been shown to improve survival compared to WBRT alone 7 . The complications of whole brain fractionated radiation include memory loss, alopecia, dementia, and radiation necrosis.

Dose Escalation

With an initial shoulder and subsequent slope is clearly identified. These cell-survival curves are best described by a linear-quadratic function. In the human context, very clear dose-dependent phenomena such as hair loss, cataract formation, skin reactions, and xerostomia can be quantified. These clinical dose-response curves are characterized by a sigmoidal shape, with low doses initially producing a relatively flat response curve, but demonstrating an upward response-inflection after a certain threshold dose, beyond which the response slope is large for a minimal change in dose at much higher doses, there is a flattening of the curve, resulting in lower incremental gain. One example of such a dose-response relationship is illustrated in Fig. 1. For malignant brain tumors such as GBM, most therapeutic trials have explored the 0 to 60 Gy dose range, a few hyperfractionation trials have explored doses up to 80 Gy and brachytherapy trials have reached 100 to 120 Gy. Although the...


One of the less sex-specific effects of androgens is that on the skin and its appendages, and in particular their action on the pilosebaceous unit. Hirsutism is the major symptom of hyper-androgenism in women. Other dermatological conditions include acne and the chronic hair loss usually termed androgenic alopecia (AGA). Whereas acne, hirsutism and chronic hair loss may coexist in the same patient, it is not unusual to find only one of these androgenic manifestations 16 .

Box 142

Hairs vary in size from long, coarse terminal hairs that may reach a meter or more in length (scalp hair and beard hair in males) to short, fine vellus hairs that may be visible only with the aid of a magnifying lens (vellus hairs of the forehead and anterior surface of the forearm). Terminal hairs are produced by large-diameter, long follicles vellus hairs are produced by relatively small follicles. Terminal hair follicles may spend up to several years in anagen and only a few months in telogen. In the balding individual, large terminal follicles are gradually converted into small vellus follicles after several growth cycles. The ratio of vellus follicles to terminal follicles increases as baldness progresses. The completely bald scalp is not hairless but is populated by vellus follicles that produce fine hairs and remain in telogen for relatively long periods.

Physical Differences

On the average, girls reach puberty 2 years earlier than boys, and in junior high school some boys may feel like shrimps alongside their female classmates. By the time both sexes have completed adolescence, females have substantially more body fat (70 more) than males but are shorter (5 inches), less muscular (40 less), and have less facial hair (Myers, 1995). These differences persist and others develop in young adulthood. For example, pattern baldness often starts showing in adult males in their late teens or early twenties. And with respect to the biology of sexual behavior, young women are more likely to become sexually aroused soon after experiencing orgasm.


Paclitaxel is also a very effective drug for the treatment of KS (Tulpule 2002). The recommended dose is 100 mg m2 body surface area administered intravenously over 3-4 hours every 2 weeks. Partial remission is achieved in up to 60 of all treated patients. Paclitaxel is myelotoxic and almost always leads to alopecia, often after just one dose. Whether paclitaxel has important interactions with HAART drugs (increase of paclitaxel toxicity ) is still under investigation (Bundow 2004). For this reason, patients on HAART and paclitaxel need very careful monitoring. Anemia, alopecia

Skin Color

Remarks For documentation of skin color, a color photograph is useful. The color of tooth enamel, nails, iris, body, and scalp hair, as well as skin, should be recorded. The skin around the nipple, especially after pregnancy, may be darker due to hormonal influences. Genital skin and areas of apocrine sweating are usually darker. Pigment changes can occur in specific diseases, such as Addison disease (a bronze skin color) or albinism (where the skin and hair pigment may be reduced or absent).

Undesirable Action

Scalp hair may be under excessive physical traction determined by fashion, e.g., tight rollers and tight hairstyles. This can result in temporary hair loss, and if continued over a long period will result in permanent hair loss (thinning). Some examples of this condition have been described by medical literature as chignon alopecia and frontoliminal alopecia.

Nuclear Structure

Effectively resulting in a protein with a 50 amino acid deletion near the C-terminus of lamin A. This deletion allows farnesylation but prevents proteolytic cleavage of the prelamin A to generate the final product. The resulting mutant lamin A acts in a dominant fashion (patients are heterozygous), and the aberrant protein is called progerin. Although mouse models accurately mimicking the human defect are now being generated in different laboratories, two potentially relevant mouse models deserve some discussion. The first is a null mouse for the gene Zmptse24 metalloproteinase, an enzyme involved in the proteolytic processing of prelamin A. Apart from nuclear abnormalities, this model shows growth retardation, alopecia, bone fractures, muscle weakness, and early cardiac dysfunction (Bergo et al., 2002). More recently, accelerated aging in these mice has been linked to p53 signalling activation, supporting the concept that hyperactivation of the tumour suppressor p53 may cause...

Back To Mitochondria

Another example of a mouse model with a defect in genome maintenance especially designed to test the hypothesis that genomic instability is involved in aging is the PolgA proofreading-deficient mouse model. PolgA, the catalytic core of the mitochondrial DNA polymerase gamma (Polg), is a mtDNA polymerase, encoded in the nuclear genome. Hence, proofreading defects in this gene would be expected to lead to increased mutations in the mitochondrial genome. Mutations in both nuclear and mitochondrial DNA have been demonstrated to accumulate with age in a tissue-specific pattern (Arnheim and Cortopassi, 1992 Vijg and Dolle, 2002). Hence, in the PolgA deficient mouse we would expect to see the premature appearance of aging-related phenotypes, which turned out to be correct. Apart from a three- to fivefold increase in mtDNA mutations in brain, heart, and liver, and respiratory chain dysfunction in the heart, a host of premature aging symptoms was observed in this mutant, including...

Colony Phenotyping

Observational assessments, summarized in Table 10.1, should include general appearance, posture, and mobility. These features can be monitored with the help of trained animal care and technical staff on a consistent and intense basis. Daily reports should be made and weekly assessments compiled. Specific aspects should be tailored to the individual research plan. For example, aging studies can include hair graying and alopecia, body weights, muscle atrophy, lordokyphosis, dermal thickness, and subcutaneous adipose. For hair regrowth assessment, hair is shaved from a 2-cm-square area at the dorso-ventral back near the base of the tail. Regrowth is defined as the first appearance of hair in each of eight sections, designated by a transparent grid, in the shaved area. Aging ad lib-fed mice have been shown to have an extended hair regrowth time compared to calorically restricted mice.9


Historical note Pygeum africanum is a large, evergreen tree native to Africa. Its bark has been used medicinally for thousands of years by traditional African healers to treat bladder disorders, kidney disease, prostate disorders, and malaria, as well as male baldness and to enhance sexual functioning. Since the late 1960s, the extract has been used in clinical practice in Europe however, because of over-harvesting, the plant is now considered an endangered species and efforts are underway to protect it.

Skin Assessment

One of the most common organs to study is the skin. It is relatively easy to examine and identify phenotypic variations which can become an important resource for gene-targeting studies. When evaluating the skin and coat, it is important to keep in mind that phenotypes can vary dramatically. Some mutations have no obvious effects, whereas others can dramatically change the appearance of the mice. Problems with the skin and coat can be due to environmental problems, parasites, autoimmune disease, nutritional disorders, or can be secondary to certain treatments or genetic changes.16 Signs to watch for include dryness, scaling, alopecia, wounds, dermatitis, piloerection, matting, and excessive oiliness to the coat. It is important to recognize that mice do a lot of grooming to themselves and each other. Barbering is common and should not be confused with alopecia. Barbering appears to be a normal dominance behavior. It is important to keep in mind that mice can respond differently to...


A multicenter, randomized, placebo-controlled, six-week, parallel group study of divalproex sodium was conducted in patients with dementia and agitation who also met criteria for secondary mania (Tariot et al., 2001). This study was designed using an aggressive dosing and titration protocol, in which a target dose of 20 mg kg day was achieved in 10 days. This plan resulted in unacceptable sedation in roughly 25 of the drug-treated group and a relatively high dropout rate, leading to premature discontinuation of the study. The original sample size was 172 nursing home residents, with 100 completers at the time the study was suspended. While there was no significant drug-placebo effect on manic features, there was a significant effect of drug on agitation as measured by the Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, 1986). Sedation occurred in 36 in the drug group versus 20 of the placebo group, and mild thrombocytopenia occurred in 7 of the drug group and none of the...


Trichotillomania involves hair-pulling episodes that result in noticeable hair loss. Although any area of the body can be a target, the most common areas are the scalp, followed by the eyelashes, eyebrows, and pubic region. Hair-pulling can occur without the individual's awareness, but is frequently preceded by a sense of increasing tension and followed by a sense of relief or gratification. The resulting hair loss can be a source of embarrassment or shame. Because of a tendency to hide symptoms, and because professionals are relatively unfamiliar with the disorder, individuals either may not seek, or are offered treatment. Untreated trichotilloma-nia can result in impaired social functioning and medical complications.

Ure 614

Blood Vessels

The skin's accessory structures also show signs of aging. Slowed melanin production causes hair to become gray or white as the follicle becomes increasingly transparent. Hair growth slows, the hairs thin, and the number of follicles decreases. Males may develop pattern baldness, which is hereditary but not often expressed in females. A diminished blood supply to the nail beds impairs their growth, dulling and hardening them. Sensitivity to pain and pressure diminishes with age as the number of receptors falls. A ninety-year-old's skin has only one-third the number of such receptors as the skin of a young adult.


Most of the etiologic and epidemiologic associations appear to point to an origin in atypical germ cells. The association of testicular maldescent and the formation of testicular tumors has been known for more than 200 years,84,85 and atypical germ cells have been identified in cryptorchid testicles.22 Similarly, testicular cancer is found more commonly in patients with testicular dysgenesis, infertility, and Kleinfelter's syndrome (with expression of an XXY chromosome). Additional epidemiologic associations include reduced body muscle mass and a lower prevalence of male pattern baldness, which may imply lower circulating testosterone levels, as either a cause or an effect of testicular cancer.86 Although testicular trauma and mumps orchitis have largely been discounted as antecedents of GCTs,87 88 earlier studies suggested that both could have mechanisms of oncogenesis predicated on testicular atrophy and the consequent evolution of atypical germ cells. Similar mechanisms have been...


Thyroid hormone plays a critical role in regulating metabolism. In hypothyroidism, the basal metabolic rate is decreased due to a lack of thyroid hormone, resulting in bradycardia, cold intolerance, alopecia, and weight gain. Neurologic symptoms are relatively common in hypothyroidism and include paresthesias in up to 80 of patients as well as ataxia, coma, headache, seizure, cerebellar signs, and psychosis (132,133). Cranial nerve involvement has also been reported, with the vestibulocochlear nerve most commonly affected in 15 to 31 of patients with hypothyroidism (132). Involvement of the facial nerve is considered rare. Its mechanism is thought to be a compressive phenomenon. In hypothyroidism, myxedematous infiltration and swelling of the soft tissue are hypothesized to have a compressive effect on the facial nerve through the tight confines of the fallopian canal. Anecdotal reports of facial nerve decompression in hypothyroidism have been described (134), but additional reports...


Procyanidins, also named condensed tannins, are flavonoids found in, e.g., pine bark (Pycnogenol), grape seeds, and fruits. By direct protein interaction, they were shown to protect collagen and elastin, two dermal matrix proteins, against their degradation 61 . Furthermore, some of these procyanidins exhibit a remarkable effect on follicle hair proliferation 62 thus extending the therapeutic applications of flavonoids to alopecia. Although the flavonoids are not part of our endogenous antioxidant defenses, they display a broad spectrum of properties particularly helpful in preventing UVR-caused deleterious effects in human skin.


In a review by Smith (17), the safety and tolerability of rHuIL-11 administered sc at the recommended dose of 50 g kg d was compared with placebo in two phase 2 studies. The dataset included 308 patients, ranging from 8 mo to 75 yr of age, who received up to eight sequential 1-28-d courses of oprelvekin. In this group, aside from complications associated with underlying malignancy or cytotoxic chemotherapy, most adverse events were of mild or moderate severity and were reversible after cessation of the growth factor. The incidence and type of adverse events were similar between patients who received oprelvekin and those who received placebo. Edema, dyspnea, tachycardia, conjunctival injection, palpitations, and pleural effusion occurred more frequently in the oprelvekin-treated patients. Adverse events that occurred in > 10 of patients and were observed in equal or greater frequency among patients receiving placebo included asthenia, pain, chills, abdominal pain, infection,...


Paronychia of the toes or fingers and ingrown toenails are typical side effects of indinavir, occurring in 4 to 9 of patients. Furthermore, approximately 30 of patients receiving indinavir show two or more mucocutaneous changes, such as cutaneous xerosis, cheilitis, hair loss or alopecia, resembling retinoid-like side effects. Indinavir is the only antiretroviral drug that induces retinoid-like effects, as it probably interferes with the retinoid metabolism. There is no relation to sex, age or immune status, but to indinavir plasma levels. In these patients, measurement of the plasma level makes sense, adjusting the dose if necessary.


Two patients were reported in 1999 by Farrell et al. 4 to have a good response to finasteride (5 mg day), a dose five times higher than that used in male alopecia. A 56-year-old man with a 10-year past history of HS reported significant improvement in his symptoms as early as the 4th week of treatment. A 55-year-old postmeno-pausal woman with a history of HS since adolescence and a previous absence of response to CPA received finasteride 5 mg day. After 3 months she reported an improvement of her lesions without any significant adverse effects.

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The best start to preventing hair loss is understanding the basics of hair what it is, how it grows, what system malfunctions can cause it to stop growing. And this ebook will cover the bases for you. Note that the contents here are not presented from a medical practitioner, and that any and all dietary and medical planning should be made under the guidance of your own medical and health practitioners. This content only presents overviews of hair loss prevention research for educational purposes and does not replace medical advice from a professional physician.

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