D.D. Munro

Alopecia areata, autoimmunity, and Down's syndrome.

Alopecia areata occurs more often in Downs syndrome than would be expected by chance, sixty cases being found among 1000 patients with this syndrome compared with one case among 1000 subnormal controls. Because alopecia areata is associated with some organ-specific autoimmune disease and thyroid antibodies are often found in Downs syndrome sera from affected patients were examined for the presence of fluorescent autoantibodies. Antibodies against thyroid components tended to be present in female mongols with alopecia areata in comparison with females in a normal population but not in male mongols. Futhermore, eight out of 23 female mongols (35%) with alopecia areata had antibodies against thyroid components compared with two out of 23 female mongols (9%) without alopecia areata.

Treatment of Psoriasis with Azathioprine

Azathioprine treatment benefited 19 (66%) out of 29 patients suffering from severe psoriasis. Haematological complications were not troublesome and results of biochemical liver function tests remained normal. Minimal cholestasis was seen in two cases and portal fibrosis of a reversible degree in eight. Liver biopsies should be undertaken at regular intervals if azathioprine therapy is continued so that structural liver damage may be detected at an early and reversible stage.

Circulating testosterone, sex hormone binding globulin and prolactin in women with late onset or persistent acne vulgaris

Serum testosterone, sex hormone binding globulin (SHBG) and prolactin were measured in thirty‐eight women with acne which persisted or started after the age of 18 years. One or more of these levels were abnormal in 76% of patients. Increased testosterone or low SHBG were present alone or in combination in 60% of patients. This group was presumed to have a raised level of non‐protein bound, metabolically‐available testosterone. Hyperprolactinaemia, which was present in 45% of patients, may be important in view of the reported association with increased adrenal androgens. The hormonal abnormalities may be causally related to the acne and a greater understanding of them may lead to better treatment.

The effect of percutaneously absorbed steroids on hypothalamic-pituitary adrenal function after intensive use in in-patients*

Hypothalamic‐pituitary‐adrenal (HPA) axis function has been monitored in adults and children who required intensive treatment of their skin disease with topical corticosteroid preparations while in hospital. Evidence of mild suppression of the HPA axis was seen in adults when the more potent topical steroids were used, but recovery of function was rapid when the intensive treatment ceased. In children suppression was still present in twelve of sixteen cases on the 2nd day after treatment with o.1%, betamethasone 17‐valerate ointment had stopped, yet in nine cases treated in a comparable manner with 1% hydrocortisone acetate ointment, there was no evidence of impaired HPA axis function.

Steroid-induced atrophy in an animal and human model

A ratchet‐controlled micrometer screw gauge has been used to measure the changes in skin thickness produced by topical corticosteroids.

Intralesional treatment of alopecia areata with triamcinolone acetonide by jet injector.

Eighty‐four patients with alopecia areata of varying degree have been treated by intralesional injections of triamcinolone acetonide, using a needleless injector (Porto‐Jet). Results indicate that, in limited alopecia, a high proportion will produce a rapid regrowth of hair. In established alopecia totalis, lasting hair growth is exceptional.

Androgen status in women with late onset or persistent acne vulgaris

The androgen status of fifty women with persistent or late onset acne vulgaris has been investigated. Abnormalities of serum androgens and sex hormone binding globulin (SHBG) alone or in combination were present in 52% of the patients. Elevated serum testosterone and low SHBG were the commonest abnormalities found (46%). Raised levels of serum dehydroepiandrosterone (DHA) and DHA sulphate were present in 16% and 12% of patients respectively, but elevation of one or other of these androgens was the sole abnormality in only 6% of patients. Serum prolactin was raised in 18% of patients but there was no correlation between prolactin and androgen levels. There was also no correlation between the androgen levels and the severity, distribution or pattern of acne or the presence of hirsuties or irregular periods. The hormonal abnormalities found in this group of patients with acne are similar to those seen in females with the polycystic ovary syndrome and idiopathic hirsuties.

Pituitary-adrenal function after prolonged use of topical corticosteroids

Forty patients with chronic skin disease who have used potent topical corticosteroids for a prolonged period were studied to determine if adrenal axis suppression had occurred. Thirty‐seven cases (92·5%) were normal when the first test was performed and all were normal when retested. Adrenal axis suppression was therefore not of importance in this group of typical outpatients with chronic skin disease. This is an important finding to put into perspective a theoretical rather than a real complication of topical corticosteroid therapy in adults.

Low sex-hormone binding globulin levels in young women with diffuse hair loss.

We measured plasma sex‐hormone binding globulin (SHBG) and testosterone levels in a pilot study of eight women aged 21–41 years who complained of diffuse hair loss; and subsequently in a larger group of fifteen patients of a similar age range. There was a significant reduction in SHBG levels in both groups of patients when compared to controls, but testosterone values were normal.

Alopecia areata: immunofluorescence and other studies

In a study of 24 patifents with alopceia areata, scalp biopsies were examined for immunofluorescence; all were negtive. A number of other tests also failed to confirm an auto‐immune acrtology for this disease. A possible explaation lies in the heterogeneity of alopecia areata, only a small proportion of cases being of the auto‐immune type.