1712
An algorithm for the diagnosis of female hair loss
Aditya K. Gupta, MD, PhD, Department of Medicine, University of Toronto,
London, Ontario, Canada; Kelly A. Foley, PhD, Mediprobe Research Inc, London,
Ontario, Canada; Danika C. A. Lyons, MS, Mediprobe Research Inc, London,
Ontario, Canada
Background: While both men and women experience, and are concerned with, hair
loss, women may experience greater psychological and social distress due to their
hair loss and are more likely to seek treatment for it. Furthermore, the similar clinical
presentations of hair loss conditions can make female hair loss difficult to diagnose.
Objective: To create an algorithm to aid physicians in arriving at an appropriate
diagnosis for hair loss in women based on patient history, clinical examination, and
differential diagnoses.
Methods: PubMed and Scopus databases, and the Hair Transplant Forum
International were searched using various terms, including ‘‘female hair loss,’’
‘‘female pattern hair loss,’’ and the different hair loss conditions.
Results: A detailed patient history is critical to establishing a trusting relationship
with patients affected by these personal conditions. The speed/duration of hair loss,
type of hair loss (shedding, thinning, or breaking), family, medication, and personal
history, and physical signs/symptoms (erythema, pruritus, scaling) can help
determine the etiology of the hair loss. The clinical examination of hair and scalp
for global appearance, physical examination of the scalp (eg, scarring vs. non-
scarring, erythema, scaling), other hair-bearing sites, directed physical examination,
and appropriate tests such as pull test, hair card, dermatoscopy, microscopic/myco-
logic examination of hair, and biopsy can provide additional diagnostic information.
When diffuse hair loss exists, consider telogen effluvium, anagen effluvium, alopecia
areata, or loose anagen syndrome. When hair loss is localized and signs of follicle
breakage indicative of trichotillomania are absent, consider alopecia areata or tinea
capitis. Patchy hair loss marginally around hairlines may be indicative of traction
alopecia. Finally, where gradual hair loss is localized to the crown or frontoparietal
central hairline (‘‘Christmas-tree’’ pattern), female pattern hair loss (androgenetic
alopecia) may be indicated.
Conclusions: Using patient history, clinical exam, and diagnostic tests, it is possible
to differentiate most hair loss conditions. This algorithm serves as a diagnostic tool to
assist physicians in diagnosing female hair loss.
Commercial support: None identified.
705
Assessment of male pattern androgenic alopecia with topical niosomal
minoxidil
Simin Meymandi, MD, Pharmaceutical Research Center, Dermatology
Department, Kerman, Medical University, Kerman, Iran; Abbas Pardakhty,
PharmD, Pharmaceutical Research Center, Dermatology Department, Kerman,
Medical University, Kerman, Iran; Rezvan Amiri, MD, Pharmaceutical Research
Center, Dermatology Department, Kerman, Medical University, Kerman, Iran;
Bahram Dabiri, MS, American University of Antigua, Coolidge, Antigua and
Barbuda; Mahin Aflatoonian, MD, Pharmaceutical Research Center, Dermatology
Department, Kerman, Medical University, Kerman, Iran
Introduction: Androgenetic alopecia (AGA) is the most common type of alopecia in
both male and female. Currently, minoxidil is the only topical drug which approved
by FDA for AGA. But efficacy is restricted because of its low skin penetration.
Vesicular system such as liposomes and niosomes can be used for the compensation
of this defect.
Materials and methods: This is a double blind clinical trial study. A total of 88 male
with AGA were enrolled in this study and data were collected and analyzed with SPSS
Version 20.
Results: There was statistically increase in hair count from first visit to last one in
both group (P \.05). Moreover, increase in hair count in niosomal minoxidil group
was more in compare to than conventional minoxidil solution (P \.001).
Conclusion: In our study, topical niosomal minoxidil revealed statically increase in
hair count in compare to conventional minoxidil solution.
Commercial support: None identified.
MAY 2015
403
Clinical utility and validity of minoxidil response testing in androgenetic
alopecia
Andy Goren, MD, Applied Biology, Inc, United States; Torello Lotti, MD,
University of Rome ‘‘G. Marconi,’’ Rome, Italy; John McCoy, PhD, Applied
Biology, Inc, Irvine, CA, United States; Janet Roberts, MD, Northwest
Dermatology and Research Center, Portland, OR, United States; Nisha Desai,
MD, Northwest Dermatology and Research Center, Portland, OR, United States;
Jerry Shapiro, MD, New York University Langone Medical Center, New York, NY,
United States
Clinical response to 5% topical minoxidil for the treatment of androgenetic alopecia
(AGA) is typically observed after 3-6 months. Approximately 40% of patients will
regrow hair. Given the prolonged treatment time required to elicit a response, a
diagnostic test for ruling out nonresponders would have significant clinical utility.
Two studies have previously reported that sulfotransferase enzyme activity in
plucked hair follicles predicts a patient’s response to topical minoxidil therapy. The
aim of this study is to assess the clinical utility and validity of minoxidil response
testing. In this communication, we conducted an analysis of completed and ongoing
studies of minoxidil response testing. The analysis confirmed the clinical utility of a
sulfotransferase enzyme test in successfully ruling out 95.9% of nonresponders to
topical minoxidil for the treatment of AGA.
This project is funded by Applied Biology, Inc
1473
Combination therapy of alopecia areata using cyclosporine and low-dose
corticosteroid: A long-term follow-up study
Wonkyung Lee, MD, Department of Dermatology, Busan Paik Hospital, College of
Medicine, Inje University, Busan, South Korea; Do Hyeong Kim, MD, Department
of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan,
South Korea; In Ho Park, MD, Department of Dermatology, Busan Paik Hospital,
College of Medicine, Inje University, Busan, South Korea; Jeong Nan Kang, MD,
Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje
University, Busan, South Korea; Se Won Jung, MD, Department of Dermatology,
Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea;
Jung Eun Seol, MD, Department of Dermatology, Busan Paik Hospital, College of
Medicine, Inje University, Busan, South Korea; Hyojin Kim, MD, Department of
Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan,
South Korea; Ho Suk Sung, MD, Department of Dermatology, Busan Paik
Hospital, College of Medicine, Inje University, Busan, South Korea
Background: Combination therapy with systemic cyclosporine and corticosteroid is
one of the treatment options of alopecia areata. There are a few studies about short-
term clinical efficacy.
Objective: The aim of this study is to evaluate the long-term efficacy of combination
therapy.
Methods: We retrospectively reviewed the medical records of patients with alopecia
areata who were treated with combination therapy using systemic cyclosporine and
low-dose corticosteroid and started it over 5 years ago. Telephone interview was
also performed if necessary. We surveyed demographic data, current state, clinical
course of patients.
Results: Among 79 subjects who satisfied the criteria, 28 were enrolled in this study.
Sex ratio of male to female was 1:2.1 (9:19). Mean time interval was 7.3 (5.7-10.5)
years and mean therapeutic period was 7.94 (0.5-35) months. Analysis of current
state revealed 35.7% (10/28) had no hair loss. Compared with hair loss status in end
point of treatment, 42.9% (12/28) of patients maintained cured condition which
means more than 90% of recovery in their alopecic patches. Half of the subjects
experienced recurrence.
Conclusions: It is likely that combination therapy using systemic cyclosporine and
low-dose corticosteroid for alopecia areata showed favorable long-term result.
Commercial support: None identified.
J AM ACAD DERMATOL AB111