[en] Knowledge of the hair follicle anatomy and the dynamics of hair cycling is substantial. Recognizing the anagen, catagen and telogen phases as well as teloptosis and the hair eclipse phenomenon clearly characterizes the typical hair chronobiology. Physiological modulators include hormones, neuromediators, miscellaneous biomolecules, seasons, micro-inflammation and ageing. For individuals who present with the complaint of increased hair shedding or alopecia, a host of evaluation techniques are available in addition to history, physical examination and laboratory assessment. Various clinical hair techniques can help in assessing the efficacy of drugs and cosmetics on hair growth. The methods are quite similar to those used to establish a definite diagnosis in dermatological practice. Great strides have been made during the recent decades in the methodology of hair growth trials in dermatology and cosmetology. Clinical evaluations benefit from a few additional specific techniques that enhance the perception of hair (re-) growth, shedding and alopecia. These assessments include the determination of hair patterning and density that may be helped by the 'black-and-white felt' examination. Daily hair counts, the 'hair pull test' and the 'hair feathering test' are also available. Instrumental methods provide reliable quantitative information that is useful if there are adequate controls. Some photographic methods, the trichogram, hair weighing and variants of the hair growth window technique including the phototrichogram, videotrichogram and tractio-phototrichogram provide insight into the complexities of hair cycling and shedding. Skin biopsy is indicated for diagnostic purposes, especially when the hair loss is accompanied by scarring.
Disciplines :
Dermatology
Author, co-author :
Pierard, Gérald ; Centre Hospitalier Universitaire de Liège - CHU > Dermatopathologie
Pierard, Claudine ; Centre Hospitalier Universitaire de Liège - CHU > Dermatopathologie
Marks, R.; Cutest Systems Limited, Heath, Cardiff, Great Britain
Elsner, P.; Department of Dermatology and Allergology, Friedrich Schiller University, Jena, Germany
Language :
English
Title :
EEMCO guidance for the assessment of hair shedding and alopecia.
Trüeb RM, and the Swiss Trichology Study Group: The value of hair cosmetics and pharmaceuticals. Dermatology 2001;202:275-282.
Cash TF: The psychological effects of androgenetic alopecia in men. J Am Acad Dermatol 1992;26:926-931.
Cash TF, Price VH, Savin RC: Psychological effects of androgenetic alopecia on women: Comparison with balding men and with female control subjects. J Am Acad Dermatol 1993;29:568-575.
Girman CJ, Rhodes T, Lilly FRW, Guo SS, Siervogel RM, Patrick DL, Chumlea WC: Effects of self-perceived hair loss in a community sample of men. Dermatology 1998;197:223-229.
Passchier J: Quality of life issues in male pattern hair loss. Dermatology 1998;197:217-218.
Piérard GE, Letot B, Henry C: Hypertrichose lanugineuse induite par le minoxidil. Dermatologica 1979;158:175-177.
Sperling LC: Hair anatomy for the clinician. J Am Acad Dermatol 1991;25:1-17.
Piérard GE, Elsner P, Marks R, Masson P, Paye M, the EEMCO Group: EEMCO guidance for the efficacy assessment of antiperspirants and deodorants. Skin Pharmacol Appl Skin Physiol 2003;16:324-342.
Piérard GE, Piérard-Franchimont C, Marks R, Paye M, Rogiers V, the EEMCO Group: EEMCO guidance for the in vivo assessment of skin greasiness. Skin Pharmacol Appl Skin Physiol 2000;13:372-389.
Hutchinson PE, Thompson JR: The size and form of the medulla of human scalp hair is regulated by the hair cycle and cross-sectional size of the hair shaft. Br J Dermatol 1999;140:438-445.
Van Scott EJ, Ekel TM: Geometric relationships between the matrix of the hair bulb and its dermal papilla in normal and alopecic scalp. J Invest Dermatol 1958;31:281-287.
Elliot K, Stephenson TJ, Messenger AG: Differences in hair follicle dermal papilla volume are due to extracellular matrix volume and cell number: Implications for the control of hair follicle size and androgen responses. J Invest Dermatol 1999;113:873-877.
Lindelöf B, Forslind B, Hedblad MA, Kaveus U: Human hair form: Morphology revealed by light and scanning electron microscopy and computer aided three-dimensional reconstruction. Arch Dermatol 1988;124:1359-1363.
Piérard-Franchimont C, Piérard GE: A propos du follicule pileux et du cycle pilaire: considérations récentes. Rev Méd Liège 1997;52:671-674.
Stenn KS, Nixon AJ, Jahoda CAB, McKay IA, Paus R: What controls hair follicle cycling? Exp Dermatol 1999;8:229-236.
Paus R: Principles of hair cycle control. J Dermatol 1998;25:793-802.
Stenn K, Parimoo S, Prouty SM: Growth of the hair follicle: a cycling and regenerating system; in Chung CM (ed): Molecular Basis of Epithelial Appendage Morphogenesis. Austin, Landes Bioscience, 1998, pp 111-130.
Piérard-Franchimont C, Piérard GE: Teloptosis, a turning point in hair shedding biorhythms. Dermatology 2001;203:115-117.
Milner Y, Sudnik J, Filippi M, Kizoulis M, Kashgarian M, Stenn K: Exogen, the shedding phase of the hair cycle growth cycle: Characterization of a mouse model. J Invest Dermatol 2002;119:639-644.
Courtois M, Loussouarn G, Hourseau C, Grollier JF: Hair cycle and alopecia. Skin Pharmacol 1994;7:84-89.
Courtois M, Loussouarn G, Hourseau C, Grollier JF: Ageing and hair cycles. Br J Dermatol 1995;132:86-93.
Guarrera M, Rebora A: Anagen hairs may fail to replace telogen hairs in early androgenetic alopecia. Dermatology 1996;192:28-31.
Guarrera M, Cipriani C, Rebora A: Delayed telogen replacement in a boy's scalp. Dermatology 1998;197:335-337.
Rebora A, Guarrera M: Kenogen: A new phase of the hair cycle? Dermatology 2002;205:108-110.
Piérard-Franchimont C, Petit L, Loussouarn G, Saint Léger D, Piérard GE: The hair eclipse phenomenon: Sharpening the focus on the hair cycle chronobiology. Int J Cosmet Sci, in press.
Lavker RM, Miller S, Wilson C, Cotsarelis G, Wei ZG, Yang JS, Sun TT: Hair follicle stem cells: Their location, role in hair cycle and involvement in skin tumor formation. J Invest Dermatol 1993;101(suppl 1):16s-26s.
Paus R, Cotsarelis G: The biology of hair follicles. N Engl J Med 1999;341:491-497.
Stenn K, Paus R: Controls of hair follicle cycling. Physiol Rev 2001;81:449-494.
Ekholm E, Sondell B, Standen P, Brattsand M, Egelrud T: Expression of stratum corneum chymotryptic enzyme in human sebaceous follicles. Acta Derm Venereol 1998;78:343-347.
Piérard G, de la Brassinne M: Cellular activity in the dermis surrounding the hair bulb in alopecia areata. J Cutan Pathol 1975;2:240-245.
Birch MP, Messenger JF, Messenger AG: Hair density, hair diameter and the prevalence of female pattern hair loss. Br J Dermatol 2001;144:297-304.
Hayashi S, Miayamoto I, Takeda K: Measurement of human hair growth by optical microscopy and image analysis. Br J Dermatol 1991;125:123-129.
Ghadially FN: Effect of trauma on growth of hair. Nature 1958;181:993.
Kolinka V, Littler CM: Mathematical modeling for the prediction and optimization of laser hair removal. Lasers Surg Med 2000;26:164-176.
Roersma ME, Veldhuis GJ: Proposal and evaluation of a Monte Carlo model for hair regrowth following plucking. Skin Res Technol 2001;7:176-183.
Piérard-Franchimont C, Piérard GE: Le cheveu anormal. Florilège des dysplasies pilaires. Rev Méd Liège 1996;51:280-290.
Itami S, Kurata S, Takayasu S: Androgen induction of follicular epithelial cell growth is mediated via insulin-like growth factor I from dermal papilla cells. Biochem Biophys Res Commun 1995;212:988-994.
Randall VA, Hibberts NA, Thornton MJ, Hamada K, Merrick AE, Kato S, Jenner TJ, De Oliveira I, Messenger AG: The hair follicle: Paradoxical androgen target organ. Horm Res 2000;54:243-250.
Labrie F, Lun-The V, Labrie C, Pelletier G, El-Alfy M: Intracrinology and the skin. Horm Res 2000;54:218-229.
Randall VA, Hibberts NA, Thornton MJ, Merrick AE, Hamada K, Kato S, Jenner TJ, De Oliveira I, Messenger AG: Do androgens influence hair growth by altering the paracrine factors secreted by dermal papilla cells? Eur J Dermatol 2001;11:304-308.
Hordinsky MK, Ericson ME: Relationship between follicular nerve supply and alopecia. Dermatol Clin 1996;14:651-660.
Slominski A, Wortsman J: Neuroendocrinology of the skin. Endocr Rev 2000;21:457-487.
Zouboulis CC: Human skin: An independent peripheral endocrine organ. Horm Res 2000; 54:230-242.
Böhm M, Luger TA: The role of melanocortins in skin homeostasis. Horm Res 2000;54:287-293.
Terezakis N, Bazzano G: Retinoids: Compounds important to hair growth. Clin Dermatol 1988;6:129-131.
Petit L, Piérard-Franchimont C, Saint Léger D, Loussouarn G, Piérard GE: Subclinical speckled perifollicular melanosis of the scalp. Eur J Dermatol 2002;12:565-568.
Randall VA, Ebling FJG: Seasonal changes in human hair growth. Br J Dermatol 1991;124:146-151.
Piérard-Franchimont C, Piérard GE: L'effluvium télogène actinique: une facette de la chronobiologie humaine. Int J Cosmet Sci 1999;21:15-21.
Piérard-Franchimont C, Uhoda I, Saint Léger D, Piérard GE: Androgenic alopecia and stress-induced premature senescence by cumulative ultraviolet light exposure. Exog Dermatol 2002;1:203-206.
Böhm M, Luger TA: The pilosebaceous unit is part of the skin immune system. Dermatology 1998;196:76-79.
Mahé YF, Buan B, Billoni N, Loussouarn G, Michelet JF, Gautier B, Bernard BA: Proinflammatory cytokines cascade in human plucked hair. Skin Pharmacol 1996;9:366-375.
Christoph T, Müller-Röver S, Audring H, Tobin DJ, Hermes B, Cotsarelis G, Rückert R, Paus R: The human hair follicle immune system: Cellular composition and immune privilege. Br J Dermatol 2000;142:862-872.
Paus R, Böttge JA, Henz BM, Maurer M: Hair growth control by immunosuppression. Arch Dermatol Res 1996;288:408-410.
Jaworsky C, Kligman AM, Murphy GF: Characterization of inflammatory infiltrates in male pattern alopecia: Implications for pathogenesis. Br J Dermatol 1992;127:239-246.
Piérard GE, Piérard-Franchimont C, Nikkels-Tassoudji N, Nikkels AF, Saint Léger D: Improvement in the inflammatory aspect of androgenetic alopecia: A pilot study with an antimicrobial lotion. J Dermatol Treat 1996;7:153-157.
Piérard-Franchimont C, De Doncker P, Cauwenbergh G, Piérard GE: Ketoconazole shampoo: Effect of long-term use in androgenic alopecia. Dermatology 1998;196:474-477.
Mahé YF, Michelet JF, Billoni N, Jarrousse F, Buan B, Commo S, Saint-Léger D, Bernard BA: Androgenic alopecia and microinflammation. Int J Dermatol 2000;39:576-584.
Piérard-Franchimont C, Hermanns JF, Degreef H, Piérard GE: From axioms to new insights into dandruff. Dermatology 2000;200:93-98.
Zouboulis CC, Boschnakow A: Chronological ageing and photoageing of the human sebaceous gland. Clin Exp Dermatol 2001;26:600-607.
Piérard-Franchimont C, Piérard GE, Paquet P: Effluviums, alopécies et hypertrichoses féminines. Dermatol Actual 2000;58:4-18.
Rushton DH, Mortimer C, James KC: The unit area trichogram in the assessment of androgen dependent alopecia. Br J Dermatol 1983;109:429-437.
Headington JE: Telogen effluvium: New concepts and review. Arch Dermatol 1993;29:56-63.
Whiting DA: Chronic telogen effluvium: Increased scalp hair shedding in middle aged women. J Am Acad Dermatol 1996;35:898-906.
Courtois M, Loussouarn G, Hourseau S, Grollier JF: Periodicity in the growth and shedding of hair. Br J Dermatol 1996;134:47-54.
Stenn KS: Growth of the hair follicle: A cycling and regenerating biological system; in Chuong CM (ed): Molecular Basis of Epithelial Appendage Morphogenesis. Austin, Landes Biosciences, 1998, pp 111-124.
Van Steensel MAM, Van Geel M, Seiljen PM: The molecular basis of hair growth. Eur J Dermatol 2001;11:348-352.
Piérard GE, de la Brassinne M: Modulation of dermal cell activity during hair growth in the rat. J Cutan Pathol 1975;2:35-41.
Paus R, Mecklenburg L, Tobin DJ: Active hair growth (anagen) is associated with angiogenesis. J Invest Dermatol 2000;114:909-916.
Sawaya ME, Keane RW, Blume-Peytavi U, Mullins DL, Nusbaum BP, Whiting D, Nicholson DW: Androgen responsive genes as they affect hair growth. Eur J Dermatol 2001;11:315-320.
Watanabe S, Kano R, Sato H, Nakamura Y, Hasegawa A: The effects of Malassezia yeasts on cytokine production by human keratinocytes. J Invest Dermatol 2001;116:769-773.
Piérard-Franchimont C, Goffin V, Henry F, Uhoda I, Braham C, Piérard GE: Nudging hair shedding by antidandruff shampoos: A comparison of 1% ketoconazole, 1% piroctone olamine and 1% zinc pyrithione formulations. Int J Cosmet Sci 2002;24:249-256.
Ramos-e-Silva M: Male pattern hair loss: Prevention rather than regrowth. Int J Dermatol 2000;39:728-731.
Hamilton JB: Patterned loss of hair in man: Types and incidence. Ann NY Acad Sci 1951;53:708-728.
Ludwig E: Classification of types of androgenetic alopecia (common baldness) arising in the female sex. Br J Dermatol 1977;97:247-254.
Piérard-Franchimont C, Piérard GE: Androgenic alopecia; in Katsambas AD, Lotti TM (eds): European Handbook of Dermatological Treatments. Berlin, Springer, 2003, pp 35-41.
Signorello LB, Wuu J, Hsieh CC, Tzonou A, Trichopoulos D, Mantzoros CS: Hormones and hair patterning in men: A role for insulin-like growth factor 1? J Am Acad Dermatol 1999;40:200-203.
Price VH, Menefee E, Sanchez M, Ruane P, Kaufman KD: Changes in hair weight and hair count in men with androgenetic alopecia after treatment with finasteride, 1 mg, daily. J Am Acad Dermatol 2002;46:517-523.
Price VH, Menefee E: Quantitative estimation of hair growth. 1. Androgenetic alopecia in women: Effect of minoxidil. J Invest Dermatol 1990;95:683-687.
Price VH, Menefee E: Quantitative estimations of hair growth: Comparative changes in weight and hair count with 5% and 2% minoxidil, placebo and no treatment; in Van Neste D, Randall VA (eds): Hair Research for the Next Millennium. Amsterdam, Elsevier, 1996, pp 67-71.
Norwood OT: Male pattern baldness: Classification and incidence. South Med J 1975;78:1359-1365.
Vecchio F, Guarrera M, Rebora A: Perception of baldness and hair density. Dermatology 2002;204:33-36.
Olsen EA: Current and novel methods for assessing efficacy of hair growth promoters in pattern hair loss. J Am Acad Dermatol 2003;48:253-262.
Caserio RJ: Diagnostic techniques for hair disorders: Clinical hair manipulations and clinical findings. Cutis 1987;40:442-448.
de la Charrière O, Deloche C, Misciali C, Piraccini B, Vincenzi P, Bastien I, Tradi I, Bernard B, Tosti A: Hair diameter diversity. Arch Dermatol 2001;137:641-646.
Olsen EA: The midline part: An important physical clue to the clinical diagnosis of androgenetic alopecia in women. J Am Acad Dermatol 1999;40:106-109.
Hornung RL, Rhodes J, West DP, Girman J: Interrater agreement of Savin density and pattern scales for male pattern hair loss. J Invest Dermatol 2000;114:887.
Guarrera M, Semino MT, Rebora A: Quantitating hair loss in women: A critical approach. Dermatology 1997;194:12-16.
Canfield D: Photographic documentation of hair growth in androgenetic alopecia. Dermatol Clin 1996;14:713-721.
Kaufman K, Binkowitz B, Savin R, Canfield D: Reproducibility of global photographic assessments of patients with male pattern baldness in a clinical trial with finasteride. J Invest Dermatol 1995;104:659.
Van Scott EJ, Reinerston RP, Steinmuller R: The growing hair roots of human scalp and morphologic changes therein following amethopterin therapy. J Invest Dermatol 1957;29:197-204.
Braun-Falco O, Heilgemeir GP: The trichogram: Structural and functional basis, performance and interpretation. Semin Dermatol 1985;4:40-52.
Piérard-Franchimont C, Piérard GE: La formule pilaire des alopécies. Nouv Dermatol 1986;5:18-21.
Piérard-Franchimont C, Piérard GE: Cycle de croissance pilaire et évaluation d'une alopécie. Praxis 1997;86:979-981.
Lachapelle JM, Piérard G: Traumatic alopecia in trichotillomania: A pathogenic interpretation of histologic lesions in the pilosebaceous unit. J Cutan Pathol 1977;4:51-67.
Guarrera M, Cuilla MP: A quantitative evaluation of hair loss: The phototrichogram. J Appl Cosmetol 1986;4:61-66.
Barth JH: Measurement of hair growth. Clin Exp Dermatol 1986;11:127-138.
Friedel J, Will F, Grosshans E: Le phototrichogramme: adaptation, standardisation et application. Ann Dermatol Vénéréol 1989; 116:629-636.
Van Neste DJJ, De Brouwer B, De Coster W: The phototrichogram: Analysis of some factors of variation. Skin Pharmacol 1994;7:67-72.
Rushton DH, De Brouwer B, De Coster W, Van Neste DJJ: Comparative evaluation of scalp hair by phototrichogram and unit area trichogram analysis within the same subjects. Acta Derm Venereol 1993;73:150-153.
Van Neste D, Dumortier M, de Brouwer B, De Coster W: Scalp immersion proxigraphy (SIP) an improved imaging technique for phototrichogram analysis. J Eur Acad Dermatol Venereol 1992;1:187-191.
Hoffmann R: TrichoScan: Combining epiluminescence microscopy with digital image analysis for the measurement of hair growth in vivo. Eur J Dermatol 2000;11:362-368.
Van Neste DJJ: Contrast enhanced phototrichogram (CE-PTG): An improved non-invasive technique for measurement of scalp and hair dynamics in androgenetic alopecia - Validation study with histology after transverse sectioning of scalp biopsies. Eur J Dermatol 2000;11:326-331.
Leroy T, Van Neste D: Contrast enhanced phototrichogram pinpoints scalp hair changes in androgen sensitive areas of male androgenetic alopecia. Skin Res Technol 2002;8:106-111.
Bouhanna P: Le tractiophototrichogramme, méthode d'appréciation objective d'une chute de cheveux. Ann Dermatol Vénéréol 1988;115:759-764.
Kullavanijaya P, Gritiyarangsan P, Bisalbutra P, Kulthanan R, Cardin CW: Absence of effects of dimethicone and non-dimethicone containing shampoos on daily hair loss rates. J Soc Cosmet Chem 1992;43:195-206.
Murphy GF, Lavker RM, Whitaker D, Korngold R: Cytotoxic folliculitis in GvHD: Evidence of follicular stem cell injury and recovery. J Cutan Pathol 1991;18:309-314.
Whiting DA, Waldstreicher J, Sanchez M, Kaufman KD: Measuring reversal of hair miniaturization in androgenetic alopecia by follicular counts in horizontal sections of serial scalp biopsies: Results of finasteride 1 mg treatment of men and postmenopausal women. J Invest Dermatol 1999;4:282-284.
Kossard S: Diffuse alopecia with stem cell folliculitis: Chronic diffuse alopecia areata or a distinct entity? Am J Dermatopathol 1999;21:46-50.
Whiting D: Dermatopathology of common hair problems. J Cutan Med Surg 1999;3:S3-S13.
Headington JT: Transverse microscopic anatomy of human scalp. Arch Dermatol 1984;120:449-456.
Whiting DA: Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia. J Am Acad Dermatol 1993;28:755-763.
Frishberg DP, Sperling LC, Guthrie VM: Transverse scalp sections: A proposed method for laboratory processing. J Am Acad Dermatol 1996;35:200-202.