M-01   HAIR RESEARCH: FROM MONTAGNA TO 2003

FM Camacho-Martínez. Trichology Unit. Hospital Virgen Macarena. Seville. Spain.

In 1980 I had the opportunity to study Hair Research, along with Professor Montagna, at the Oregon Regional Primate Centre; especially hair follicle microscopical studies and female monkey castration to observe the evolution of androgenetic alopecia in four types of monkeys. I have never worked again on animal research ever since. Over the past twenty two years I have been engaged at the Trichology Unit of the Department of Dermatology of the University of Seville, focussing on three particular trichological fields: 1) hair and androgens: male/female androgenetic alopecia, SAHAs and hirsutism; 2) alopecia areata and other acquired alopecias; 3) hair dysplasias. At this Unit we carry out microscopical, biochemical, immunological, clinical, therapeutical, epidemiological and statistical studies.

1. Hair and androgens In the field of androgenetic alopecia I have introduced the classification of AGA, since there are not only MAGAs or FAGAs but also cases of males with alopecia of female pattern and females with alopecia of male pattern. We have studied the normal levels of androgens in our male/female population and we were able to state the following: when advances stages of MAGA are present at an early age, the majority of males present an increase of adrenal hormones, especially 17-OH-progesterone as well as testosterone. When women have androgenetic alopecia of male pattern the adrenal hormone levels are higher; when the pattern is female, but advanced, the increased hormones are ovaric androgens. The MAGA.F, at least at the beginning, is a form of advanced MAGA with increased adrenal or testicular androgens. When this type of alopecia is controlled with minoxidil or finasteride, the patients present a typical MAGA. The only therapeutical surveys that we consider of interest are those which employed minoxidil at diverse concentrations and VEGF locally, and oral finasteride. Women may present a slight form of hyperandrogenism with alopecia, hirsutism, acne and seborrhea (know by its achronym SAHA). Today we admit five types of SAHA: constitutional, ovaric, adrenal, pituitary and HAIRAN syndrome. Dermatologists should know this, and diagnose and treat such patients accordingly; otherwise, these women will end up developping a policystic ovarian syndrome. SAHA is also a step in the development of hirsutism; for this reasons we consider currently the same classification. The biochemical investigation shows correlation between type of hirsutism and high hormone levels; on the other hand, the therapeutical investigation shows differences as to the origins.

2. Alopecia areata and other acquired alopecias In the field of alopecia areata we have been studying the different modalities of clinical forms and treatment. We described SISAIFO and androgenetic alopecia type, and we have performed different treatment protocols in relation with type and age. Although in the first years we used corticosteroids in all types of alopecia areata, today we only use intralesional glucocorticoids on the plaques, and systemic glucocorticoids in those cases with a clear alteration of cellular or humoral immunity. In our Unit children are usually treated with zinc aspartate 100 mg/day and biotine 20 mg/day. In a second term, we use intralesional corticosteroids; in non responsers we prescribe SADBE. In adults, at first we used the same treatment as in children, exception made of those who were antinuclear antibodies positive or had CD4/CD8 levels over 2.5; in such cases we administrated corticosteroids per os. In non-responders we used DFC. Other acquired alopecias diagnosed and treated at our Unit were UV alopecias (in conjunction with our UVRadiation and Skin Cancer Unit). Also, we have been working out the different treatment possibilities of scarring alopecia (in conjunction with our Surgical Unit).

3. Hair dysplasias In the field of hair dysplasias we had the chance to work near Huelva, which is an area with a high consanguinity ratio. This situation enabled us to observe all types of dysplasia and describe some as "pili bi-bifurcati"; it also lead us to re-classify the pili multigemini, pseudomonilethrix and monilethrix.

4. Microscopical studies. Research. Lastly, I would like to remind all young trichologists that the trichogramm (or microscopical study of bulge and hair shaft) is not as useless as many dermatologists sustained. It is true that the trichogramm is of no use to study androgenetic alopecias; but, when the hair samples are sistematically taken out of the same scalp area, the trichogramm is very useful to find out whether the treatment evolution is correct. It also allows to observe the benefits of minoxidil treatment, especially if the patient has used a vascular endothelial growth factor (VEGF) before. When the patient was treated with minoxidil in an adequate way, it is possible to observe a good blood supply in the vitrea membrane, which entirely comes out from the new follicles when uprooted. But, when the patient was treated with VEGF before, the rest of connective tissue (containing remanents of blood vessels, nerves and connective tissue sheaths of the follicle) multiply its arterial network and occasionally give rise to "vascular bags" with one or two pedicles to provide more blood to the papillar and bulb cells.