Randomized Therapeutic Trial For Patients With Alopecia Areata

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Randomized Therapeutic Trial For Patients With Alopecia Areata

Transcript Of Randomized Therapeutic Trial For Patients With Alopecia Areata

RANDOMIZED THERAPEUTIC TRIAL FOR PATIENTS WITH ALOPECIA AREATA
Dissertation Submitted in fulfillment of the university regulations for
MD DEGREE IN DERMATOLOGY, VENEREOLOGY AND LEPROSY
(BRANCH XII A) Madras Medical College
Chennai
THE TAMILNADU DR.M.G.R.MEDICAL UNIVERSITY CHENNAI
MARCH 2010

CERTIFICATE
Certified that this dissertation entitled “RANDOMIZED THERAPEUTIC TRIAL FOR PATIENTS WITH ALOPECIA AREATA” is a bonafide work done by DR. G. MEERA, Post Graduate Student of the Department of Dermatology, Venereology and Leprosy, Madras Medical College, Chennai – 600 003, during the academic year 2007 – 2010. This work has not previously formed the basis for the award of any degree.
Prof.Dr.D.PRABHAVATHY, MD.DD, Professor and Head of the Department, Department of Dermatology and Leprology, Madras Medical College, Chennai-600003.
Prof. Dr. J.MOHANASUNDARAM, M.D.Ph.D, DNB., Dean, Madras Medical College, Chennai-600003

SPECIAL ACKNOWLEDGEMENT
My sincere thanks to Prof. Dr.J.MOHANASUNDARAM, M.D.,PhD,DNB Dean, Madras Medical College for allowing me to do this dissertation and utilize the institutional facilities.

ACKNOWLEDGEMENT
I am gratefully indebted to Prof. Dr.D.PRABHAVATHY, MD.DD, Professor and Head, Department of Dermatology and Leprology for her invaluable guidance, motivation and help throughout the study. I would like to express my sincere and heartfelt gratitude to Dr.N.KUMAR, M.D.D.V.,D.M.R.D., Director in charge Institute of Venereology for his guidance.
I express my earnest gratitude to Dr.S.V.Somasundaram, MD.DD, Professor and Head, Department of Occupational Dermatology and Contact Dermatitis for his constant motivation and guidance. I thank Dr.V.Thirunavukarasu MD.DD, Additional Professor, Department of Occupational Dermatology and Contact Dermatitis for his benevolent help and support.
I am grateful to Dr.S.Jayakumar, M.D.,D.D., Additional Professor, Department of Dermatology for his invaluable guidance and help. I express my sincere gratitude to Dr.R.Arunadevi, MD.,DD., Additional Professor(Leprosy). I sincerely thank Dr.C.Janaki, M.D.,D.D., Reader of Dermatology (Mycology) for her priceless support.
I wish to thank Dr.B.Parveen, M.D.,D.D., Former Professor, Department of Dermatology and Dr.K.Gajendran, M.D.,D.V., Former Director, Institute of Venereology for their constant support and motivation.

My sincere thanks go to Dr.S.Kumaravel M.D,D.D., Dr.G.K.Tharini M.D., Dr.J.Manjula, M.D.,DNB, Dr.S.J.Daniel MD(DVL) and Dr.S.Anupama Roshan, D.D.V.L., Assistant professors Department of Dermatology for their kind support and encouragement.
I humbly thank my Guide, Dr.V.Anandan, M.D.DCH.,DNB (paediatrics), Dr.N.Hema, M.D., - Asst professors for their valuable guidance throughout my work.
I thank Dr.A.Hameedullah., M.D.,D.D., and Dr.Afthab Jameela Wahab M.D.,D.D., Assistant Professors, Department of Occupational Dermatology and Contact Dermatitis for their support and help.
I am inclined to thank Dr.V.Thirunavukarasu, M.D.,D.V., Dr.K.Venkateswaran, M.D.,D.V., Dr.P.Mohan, M.D.,D.V., Dr. S. Thilagavathy M.D.,D.V., Dr.S.Arunkumar M.D.,D.V., Dr.S.Kalaivani, M.D.,D.V., Dr. Ahmed Shariff MD(DVL) and Dr.P.Prabahar, M.D.(DVL) Assistant Professors, Department of Venereology, for their help and suggestions.
I express my sincere gratitude to Dr.Jayakumari Jeevan, MD.,DD., Former Professor of Leprosy for her support
I am thankful to Dr. N. Narayanan M.Pharm.,Ph.D Department of pharmaceutics for his valuable help.
I duly acknowledge the paramedical staff and my colleagues for their help and favors. Last but not the least I am profoundly grateful to all patients for their co-operation and participation in this study.

CONTENTS

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Title

1. INTRODUCTION 2. REVIEW OF LITERATURE 3. AIM OF THE STUDY 4. MATERIALS AND METHODS 5. OBSERVATIONS 6. DISCUSSION 7. CONCLUSION
ANNEXURES REFERENCE PROFORMA MASTER CHARTS

Page No. 1 2 35 36 43 61 73

INTRODUCTION
In humans, hair's main purpose revolves around its profound role in social interactions. Oliver Herford said “A hair in the head is worth two in the brush”. Given their prominence in daily dermatologic practice, hardly any dermatologist can escape having to manage patients with hair growth disorders.
ALOPECIA AREATA (Abbreviation : AA) is a chronic, organ-specific autoimmune disease, probably mediated by autoreactive T cells, which affects hair follicles and sometimes the nails. Although not life threatening, the cosmetic disfigurement that leads on to significant psychological and emotional distress supports a multibillion-dollar effort to reverse this condition.
Though various modalities are available for the treatment of alopecia areata, assessment of the efficacy of a treatment must be considered with care because the condition is highly unpredictable in presentation, evolution, and response to treatment. Little data exist regarding the natural evolution of the condition. Hence with this in mind the following study was carried out to see the treatment response for various modalities and chances of spontaneous resolution for this benign condition.
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REVIEW OF LITERATURE
INTRODUCTION
Hair is a cutaneous appendage typical of mammalian skin1. It has lost its functional value in humans except probably over the scalp. With the exception of the palms, soles, dorsa of terminal phalanges of digits1, glans penis and mucocutaneous junctions, the entire skin surface is populated by hair follicles. The follicular density (number of hair follicles/cm2) decreases with age.
HAIR CYCLE
Hair grows in cycles of various phases:2 anagen is the growth phase( 2 – 10 yrs); catagen is the involuting or regressing phase(1 - 3 wks); followed by telogen, the resting or quiescent phase (3 months). Prior to the start of cycling is a phase of follicular morphogenesis (formation of the follicle). There is also a shedding phase, or exogen, that is independent of anagen and telogen in which one of several hairs that might arise from a single follicle exits. Normally up to 90% of the hair follicles are in anagen phase while, 10–14% are in telogen and 1–2% in catagen. The cycle's length varies on different parts of the body. Growth cycles are controlled by a chemical signal like epidermal growth factor.
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ALOPECIA AREATA (AA) – DEFINITION
Alopecia Areata is defined as a sudden or gradual complete loss of hair in sharply defined round or oval patches without accompanying atrophy or inflammation resulting in non scarring smooth patch of baldness. Hippocrates first used the term alopecia (literally translated as “Fox’s disease”). Alopecia areata was first described by Cornelius celsus in 30AD & Sauvages used the term alopecia areata.
SYNONYMS3
Alopecia Celsi, Porrigo Decalvans, Alopecia Circumscripta, Cazenave's Vitiligo, Celsus' Vitiligo, Vitiligo capitis, Alopecia cicatrisata, Fox’s disease, Jonston's Alopecia, Area celsi , Area tonstonii, Pelade of the French, Tinea decalvans & Ophiasis of the Greek.
SUBTERMS OF ALOPECIA AREATA4
Alopecia areata : Most commonly used term covering all forms of the disease.
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Alopecia partialis: Name given to specific patchy hair loss. Alopecia Totalis: Complete loss of terminal hair on the scalp. Alopecia Universalis: Total loss of all terminal hair on the scalp and body.
Oophiasis : Band-like pattern of hair loss at the periphery of the scalp. Usually affecting the occipital and temporal region. Oophiasis comes from the latin word ‘Snake’ and in Greek means serpent due to the winding turban or snake like pattern of hair loss on the periphery of the scalp.
Sisaipho AA: It is defined as entire loss of scalp hair except for a narrow ring of hair around the periphery. This term is used by a clinical group in Seville, Spain (Munoz1996)
Alopecia Areata Barbae: Alopecia affecting the hair of the beard region.
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DermatologyDepartmentProfessorMadrasScalp