Rodney P. R. Dawber

Androgenetic alopecia in men and women

All men and women suffer androgenic hair loss as they age. Androgenic alopecia becomes a problem only when the hair loss is perceived as excessive, premature and distressing.

Curettage, electrosurgery and skin cancer.

The scientific literature is replete with reports extolling the virtues of curettage and electrosurgery in the treatment of skin disease. Published cure rates for selected skin cancers consistently equal those for other treatment modalities, including scalpel excision. Despite this, curettage is often overlooked as a first line treatment for skin cancer. We review the evidence‐based literature for patient selection criteria and curettage and electrosurgery techniques.

Treatment of lentigo maligna

Lentigo maligna (LM) is the in situ phase of lentigo maligna melanoma (LMM) and, if left untreated, 30‐50% of cases will progress to LMM, which is now thought to behave as aggressively as any other melanoma. Literature on the of treatment of LM including conventional surgery, micrographic Mohs surgery, cryosurgery, radiotherapy, electrodesiccation and curettage, 5‐fluorouracil (5‐FU), azelaic acid, retinoic acid and lasers are reviewed. It is concluded that micro‐graphic Mohs surgery has the lowest recurrence rates and that conventional surgery, cryosurgery and radiotherapy all have recurrence rates in the order of 7‐10%. Therefore, on the basis of the current literature available, all three of these methods could be recommended as primary treatment of LM. It is extremely important when choosing one of the above treatments that the physician is adequately trained in the appropriate technique and understands the limitation of the method used and the need for close follow up of the patient

Cryosurgery in the treatment of basal cell carcinoma : Assessment of one and two freeze-thaw cycle schedules

background It has become routine practice in many centers to use two successive freeze‐thaw cycles in the treatment of the common types of basal cell carcinoma. Because of the potential morbidity caused by this, we have investigated the cure rate achieved with one freeze‐thaw cycle compared with that achieved with two freeze‐thaw cycles in the treatment of facial basal cell carcinomas of a uniform type and clinically in the best prognostic group. Superficial truncal basal cell carcinomas are reported to respond to less aggressive cryosurgery, and we have investigated the cure rate achieved with one freeze‐thaw cycle. objective To compare the efficacy of one freeze‐thaw cycle versus two freeze‐thaw cycles in the treatment of facial basal cell carcinomas. Second, to investigate the efficacy of one freeze‐thaw cycle in the treatment of superficial truncal basal cell carcinomas. This was investigated in a prospective randomized post‐treatment follow‐up study. method Over the past 7 years, we have treated 84 facial basal cell carcinomas with either a single 30‐second freeze‐thaw cycle or a double 30‐second freeze‐thaw cycle. Patients were allocated randomly into one of the two treatment schedules, and the cure rates achieved were compared. Second, 29 superficial truncal basal cell carcinomas were treated with a single 30‐second freeze‐thaw cycle. Patients were followed up to assess response to therapy. result A 95.3% cure rate was achieved in the treatment of facial basal cell carcinomas with a double freeze‐thaw cycle. This compared with a cure rate of only 79.4% when facial lesions were treated with a single freeze‐thaw cycle. Treatment of superficial truncal basal cell carcinomas with a single freeze‐thaw cycle achieved a cure rate of 95.5%. conclusion We recommend that, in order to achieve high cure rates that are equivalent to many reports of formal excision or radiotherapy, facial basal cell carcinomas require a double freeze‐thaw cycle with liquid nitrogen. One freeze‐thaw cycle to truncal basal cell carcinomas achieves high cure rates, equal to that achieved with a double freeze‐thaw cycle to facial basal cell carcinomas.background It has become routine practice in many centers to use two successive freeze-thaw cycles in the treatment of the common types of basal cell carcinoma. Because of the potential morbidity caused by this, we have investigated the cure rate achieved with one freeze-thaw cycle compared with that achieved with two freeze-thaw cycles in the treatment of facial basal cell carcinomas of a uniform type and clinically in the best prognostic group. Superficial truncal basal cell carcinomas are reported to respond to less aggressive cryosurgery, and we have investigated the cure rate achieved with one freeze-thaw cycle. objective To compare the efficacy of one freeze-thaw cycle versus two freeze-thaw cycles in the treatment of facial basal cell carcinomas. Second, to investigate the efficacy of one freeze-thaw cycle in the treatment of superficial truncal basal cell carcinomas. This was investigated in a prospective randomized post-treatment follow-up study. method Over the past 7 years, we have treated 84 facial basal cell carcinomas with either a single 30-second freeze-thaw cycle or a double 30-second freeze-thaw cycle. Patients were allocated randomly into one of the two treatment schedules, and the cure rates achieved were compared. Second, 29 superficial truncal basal cell carcinomas were treated with a single 30-second freeze-thaw cycle. Patients were followed up to assess response to therapy. result A 95.3% cure rate was achieved in the treatment of facial basal cell carcinomas with a double freeze-thaw cycle. This compared with a cure rate of only 79.4% when facial lesions were treated with a single freeze-thaw cycle. Treatment of superficial truncal basal cell carcinomas with a single freeze-thaw cycle achieved a cure rate of 95.5%. conclusion We recommend that, in order to achieve high cure rates that are equivalent to many reports of formal excision or radiotherapy, facial basal cell carcinomas require a double freeze-thaw cycle with liquid nitrogen. One freeze-thaw cycle to truncal basal cell carcinomas achieves high cure rates, equal to that achieved with a double freeze-thaw cycle to facial basal cell carcinomas.

Mohs micrographic surgery for the treatment of in situ nail apparatus melanoma: A case report

Nail apparatus melanoma (or subungual melanoma) is rare and accounts for only 1.4% of all cutaneous melanomas in the United Kingdom. We report the use of fixed-tissue Mohs micrographic surgery to treat a biopsy-proven Clark level I in situ nail apparatus melanoma, presenting with diffuse longitudinal melanonychia.

Methods of evaluating hair growth

For decades, scientists and clinicians have examined methods of measuring scalp hair growth. With the development of drugs that stem or even reverse the miniaturization of androgenetic alopecia, there has been a greater need for reliable, economical and minimally invasive means of measuring hair growth and, specifically, response to therapy. We review the various methods of measurement described to date, their limitations and value to the clinician. In our opinion, the potential of computer‐assisted technology in this field is yet to be maximized and the currently available tools are less than ideal. The most valuable means of measurement at the present time are global photography and phototrichogram‐based techniques (with digital image analysis) such as the ‘TrichoScan’. Subjective scoring systems are also of value in the overall assessment of response to therapy and these are under‐utilized and merit further refinement.

Apparent fragility of African hair is unrelated to the cystine‐rich protein distribution: a cytochemical electron microscopic study

Abstract:  A feature of black African hair is an apparent increased fragility of the hair shaft compared to other ethnic groups (as measured by the tensile force needed to break the hair fibre). This has certain similarities to that reported for trichorrhexis nodosa (weathering secondary to physical damage) and trichothiodystrophy [a genetic disorder associated with reduced cystine (sulphur)‐rich proteins and increased fragility]. In the present study, the distribution of the cystine‐rich proteins in the hair of black Africans was compared to that of Caucasian and Asian volunteers, plus patients with trichorrhexis nodosa and trichothiodystrophy, using transmission electron microscopy and specific silver stains. It was found that the silver staining pattern of the hair shafts of black Africans was similar to that observed for Caucasians, Asians and also patients with trichorrhexis nodosa. The cuticular cells exhibited an electron dense A layer and exocuticle, and in the cortex the microfibrils forming the macrofibres were outlined by electron‐dense material. This contrasts with the abnormal distribution of the cystine‐rich proteins seen in trichothiodystrophy. This study is the first formal comparison of the cystine‐rich proteins in the various racial groups and shows that there is no abnormality in their distribution in black African hair shafts compared to the other ethnic groups. Therefore, the excessive structural damage observed in the African hair shafts is consistent with physical trauma (resulting from grooming) rather than an inherent weakness due to any structural abnormality.

Finasteride, a Type 2 5α-reductase inhibitor, in the treatment of men with androgenetic alopecia

In men who are genetically predisposed to develop androgenetic alopecia (AGA; male pattern hair loss), endogenous androgens alter scalp hair follicles, resulting in production of vellus-like, miniaturised hair, rather than cosmetically significant terminal hair. This change leads to a progressive decline in visible scalp hair density, readily perceived by the patient as thinning and, eventually, baldness. Dihydrotestosterone (DHT), a metabolite of testosterone produced by the enzyme 5alpha-reductase, has been implicated as the specific androgen in the pathogenesis of AGA. Men genetically deficient in the Type 2 isoenzyme of 5alpha-reductase do not develop AGA. Moreover, Type 2 5alpha-reductase has been detected in scalp hair follicles, and balding scalps contain increased Type 2 5alpha-reductase activity and DHT levels. Taken together, these findings provide a rationale for the use of Type 2 5alpha-reductase inhibitors in the treatment of men with AGA. Finasteride, a specific and potent inhibitor of human Type 2 5alpha-reductase, decreases the formation of DHT from testosterone. Originally developed for the treatment of men with benign prostatic hyperplasia (BPH) as a 5 mg tablet, finasteride was subsequently evaluated as a treatment for AGA. Clinical studies in balding men demonstrated that finasteride reduced scalp DHT levels and improved hair growth, confirming the role of DHT in the pathophysiology of AGA. Dose-ranging studies established the optimal dose of 1 mg/day for the treatment of men with this disorder. Large, multicentre studies established the safety and efficacy of finasteride 1 mg, leading to marketing of Propecia (finasteride 1 mg) as a new treatment for men with AGA.

Golf Tee Hairs in Netherton Disease

Abstract: We present a case of r4etherton disease, where the hairs lacked the characteristic microscopic feature of Uichorrhexis invaginata. In its piace were certain hairs with a goif tee tnorphoiogy. These represent the proximal half of the invaginate node seen in typicai Netherton disease. Scanning eiectron microscopy demonstrated the three‐dimensiona) quality of this abnormaiity, which is subtie when assessed by iight microscopy aione. We describe this sign so that it might be recognized when seen in isolation, as here, and aiiow tire diagnosis of Netherton disease to be confirmed.

THE BASEMENT MEMBRANE ZONE OF THE NAIL

The anatomy of the epidermis, dermis and subcutaneous tissues of the nail apparatus is distinct from that of non‐appendageal skin. Apart from the demonstration of the longitudinal configuration of the dermal‐epidermal junction of the nail bed, there have been no studies of the composition of the basement membrane zone of the nail apparatus. We obtained three human accessory digits, including one thumb, all of which had been amputated for cosmetic reasons, and were without known pathology. Specimens were stained with a battery of monoclonal and polyclonal antibodies which target normal basement membrane zone antigens, and studied by indirect immunoflourescence.