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In a selected group of 8 patients with progressive alopecia areata (AA) leading to AA universalis, immunological aspects (in the peripheral blood and the tissue) were studied during the period of the initial attack of the disease. The peripheral T-cell helper/suppressor ratio appeared not to be a reliable parameter for the disease activity. The intrabulbar and peribulbar distribution of T-cells, Langerhans cells and of HLA-DR expression in and around the anagen hair follicles in the progressive areas of the disease (region of exclamation-mark hairs) may suggest a T-cell-mediated injury primarily in the peribulbar regions of the follicles. The data presented tend to support the possibility that in the early development of AA, the dermal pailla (capillary network?) may be the prime target of immunologic injury.

Summary A scanning electron microscope was used to compare the distal ends of exclamation mark hairs from alopecia areata patients with the fracture surface of normal hair fibres, mechanically broken by traction. The exclamation mark hairs shows minimal damage to the cuticular cell pattern of the hair shaft. Where the cuticle was absent, cortex and medulla showed low-density features fanning out into a fringe-like structure at the distal ends. The fracture surfaces of normal hair fibres, mechanically broken by traction showed a markedly abnormal cuticular scale-pattern, whereas the features of cortical and medullary tissue were normal. These morphological differences between the fracture surface of exclamation mark hairs and normal hair fibres, mechanically broken by traction, may enhance our understanding of the pathogenesis of alopecia areata.

The hair root status was used to evaluate the effect of cyproterone-acetate (CA), given orally, on hair cycle in a clinically homogeneous group of 11 women with idiopathic hirsutism. The therapy was continued for 12 menstrual cycles of treatment. The hair root status on the left upper leg and chin was determined before, directly after CA-treatment and 3 months later. The absolute number of anagan hair roots in both fields was decreased directly after therapy. Three months later this value on the upper leg increased again significantly while on the chin there was no significant increase in this period. The number of catagen/telogen hair roots showed no significant differences before, directly after CA-treatment and 3 months later. The number of regrowing hairs on the upper leg showed a significant increase of dysplastic-dystrophic hair roots.

The influence of epilation by means of diathermy and galvanic current on the hair roots in the beard region of 11 women with idiopathic hirsutism has been investigated. The hair-roots could be destructed by both methods. Various differences were found between the two methods: 1. After 10 weeks, the hair density in the field treated by diathermy was lower than that in the corresponding field treated with galvanic current. However, the time required for total destruction of all hair roots was found to be the same for both methods. 2. The diameter of the hairs growing again after diathermy was found to be less than that after galvanic current, while the proportion of dysplastic/dystrophic hairs was significantly greater.

The effect of various methods of depilation (shaving with razor and soap and with a so-called lady-shave; depilatory cream, depilatory resin) was studied in 15 women with idiopathic hirsutism. No statistically significant difference was found between the density of hairgrowth before, and that after, a single depilation or a series of twelve depilations. No change in activity of the hair follicle was observed four weeks after the last depilation.

The effect of Anandron, a novel non-steroidal anti-androgen, on the reduction in sexual hair growth of 14 male-to-female transsexuals was investigated. Anandron (300 mg/day) alone for 8 weeks increased serum testosterone levels (mean: 19.2 +/- 6.1 to 44.9 +/- 11.5 mmol/l) and serum oestradiol levels (mean: 0.08 +/- 0.02 to 0.24 +/- 0.06 nmol/l). From Weeks 9 to 20, ethinyloestradiol (100 micrograms/day) was co-administered. Hair growth scores, hair weight and the number of terminal hairs decreased significantly in the first 8 weeks and continued to decrease during the second period in the areas assessed (the trunk and the limbs). In addition, there was a subjective decrease in hair growth on the limbs and the trunk, but not on the face. We suggest that Anandron alone and in conjunction with oestrogens is effective in reducing sexual hair growth on the limbs and the trunk.

Twenty female patients suffering from androgenetic alopecia were treated during one year with 50 micrograms ethinyloestradiol plus 2 mg cyproterone acetate and additional 20 mg cyproterone acetate on days 5-20 of the menstrual cycle. The control group consisted of eight untreated female patients with androgenetic alopecia. The parameters used to evaluate therapeutic results were trichogram, hair shaft diameter of full anagen and number of hairs measuring less than 40 microns. Hair roots were epilated from two locations of the scalp: fronto-cranial and left temporal (reference point). The trichogram of the fronto-cranial scalp region showed an increase of anagens as well as a decrease of telogens. These changes were statistically highly significant. Further, there was a decrease of dysplastic/dystrophic forms. The left temporal scalp region showed no significant differences. The mean hair shaft diameter of full anagen (n = 8) increased, while the number of hairs measuring less than 40 microns (n = 8) decreased. The last two findings showed no statistically significant differences. The therapeutic results warrant the conclusion that cyproterone acetate seems to be effective in androgenetic alopecia in women.

The cycle of hairgrowth is divided into the anagen, the catagen and the telogen phases, the durations of which are 2–6 years, 3–4 weeks and 3–4 months respectively for the scalp.