Correspondence
233
other types of traction alopecia, the periphery of the scalp, especially in the frontal and parietal regions, is chiefly involved (Fig. 2). Treatment is 10 make the hair-do looser. In early and mild cases full regrowth may occur, but in longstanding cases this may be incomplete. „
, r.
•
r e -
J w T^
GURMOHAN S I N G H
Head, Section of Skin and V.D., Institute of Medical Sciences, Banaras Hindu University, Varanasi, India CIRCULAR REGROWTH IN ALOPECIA AREATA SIR, Treatment of alopecia arcata with conicosteruids, both by local application and by intradermal injection, has been practised lor many years. Iniralesional injections appear to be the most effective, but there Js no doubt that the more potent topical preparations can promote some degree of regrowth, although relapse is common with both methods (Abell & Munro, 1973; Leyden & Kligman, 1972). In alopecia areata a centrifugal wave of hair follicle damage is followed hy a regrowth of new hairs {Eckert, Church & Ebling, 1968). We have recently seen eight patients in whom the regrowth has taken a peculiarly circular form. All of these patients had been using Huorlnated corticosteroid applications (Table i). Four patients admitted that they applied the preparation by rubbing vigorously in a circular manner. TABLE I. Preparations ust-J and duration of treatment Sex
Age
Steroid preparation
I 2
F F
38
3 4 5
F F M F M
S>~nalar Forte Betnovaic Scalp Application Synalar Forte Synalar Forte Synalar Forte SvTiaUr Forte Synalar Forte S>iialar Gel
Case
6 7 8
M
13 21
3« 25 24
49 39
Duration ol" use when regrowth noted (weeks) 10
8
S II
8 z6 i«
6
Circular rubbing Denied Admitted Denied Admiitcd Possible Possible Admitted Admitted
All ofthe lesions subsequently rcgrew hair in the central area and eventually disappeared (Figs i, 2 and 3). We wonder if this peculiar regrowth pattern is an artefact due to the unconscious tendency to rub in a circular manner with maximum concentration at the edge of the lesion, or whether it is related to the ripple like spread of disease activity. ACKNOWLEDGMENT We would like to thank the photographic department of St John's Hospital for Diseases of the Skin for the illustrations. „,
.
„
. ,
Westminster Hospital, London SAV.i. St George's Hospital, London S.W.i.
R.S.H.TAN
T.J.DELANEY
234
Correspondence REFERENCES
ABELL, E . & MUNHO, D . D . (T973) Intralesional ireatment of alopecia areata with triamdnolone acetonide by jet injector. Brirish Journal of Dermatology, 88, 55. ECKERT, JOANNA, CHURCH, R.E. & EBLING, F.J. (1968) The paihogenesis of alopecia areata. British Journal of Dermatology, 80, 203. J J.J. & KLIGMAN, A.M. (1972) Treatment of alopecia areata with steroid solution. Archives of Dermatology ^ 106, 924.
FIGURE I. Patient No. 7. Circular regrowth in characteristic pattern after application of steroid for 16 weeks.
2. Sanic ^rca as Fig. i, 8 weeks later.
Correspondence
235
FIGURE I. Same area as Fig. i, ro weeks later.
Book Reviews Proceedings of the 14th International Congress of Dermatology, Padua/Venice, 22-27 1972. F.FLARER, F.SERRI and D.W.K.COTTON (Ed.) (1974) Amsterdam: Excerpta Medica. Pp. 1008, illustrated. Price £44.80 The proceedings of the Venice International Congress cover virtually all aspects of dermatology. They should therefore, and do, contain something of value for everyone, albeit somevi-hat diluted. The list of contents alone runs to 22 pages. The papers which succeed most are cither those where a world authority highlights the salient problems of some larger prohlem, without attempting to cover the whole field, or the shorter papers which convey only a single simple message. For example, the review of immimotherapy of malignant melanoma by Kopf brings together material from many sources. It is now generally accepted that International Congresses are not the forum where new material is presented, and virtually nothing emerges that has not appeared in print elsewhere. However, few can be aware, for instance, of the distinctive acral psoriasiform eruption described by Bazex, Dupre and Christol, which so far has been associated with a systemic carcinoma as regularly as is acanthosis nigrigans. Many of the genodermatoses described are also likely to be unfamiliar. The papers are all written in English, a remarkable tribute to somebody's industry. Some authors have been content to allow their original summary printed before the Congress to be published, and several have failed to provide even a key bibliography. The editors and publishers are to be congratulated on marshalling together so attractively such unwieldy material, much of which was perhaps more suitable for verbal than written presentation. Most individual dermatologists will probably feel that the average amount of useful information per page makes this book too expensive to buy, but will nevertheless find that there is much of value in it and they will want access to it in libraries. It can be appreciated why the organizers of the next congress are apparently considering alternative ways of recording the proceedings. R.H.CHAMPION
233
other types of traction alopecia, the periphery of the scalp, especially in the frontal and parietal regions, is chiefly involved (Fig. 2). Treatment is 10 make the hair-do looser. In early and mild cases full regrowth may occur, but in longstanding cases this may be incomplete. „
, r.
•
r e -
J w T^
GURMOHAN S I N G H
Head, Section of Skin and V.D., Institute of Medical Sciences, Banaras Hindu University, Varanasi, India CIRCULAR REGROWTH IN ALOPECIA AREATA SIR, Treatment of alopecia arcata with conicosteruids, both by local application and by intradermal injection, has been practised lor many years. Iniralesional injections appear to be the most effective, but there Js no doubt that the more potent topical preparations can promote some degree of regrowth, although relapse is common with both methods (Abell & Munro, 1973; Leyden & Kligman, 1972). In alopecia areata a centrifugal wave of hair follicle damage is followed hy a regrowth of new hairs {Eckert, Church & Ebling, 1968). We have recently seen eight patients in whom the regrowth has taken a peculiarly circular form. All of these patients had been using Huorlnated corticosteroid applications (Table i). Four patients admitted that they applied the preparation by rubbing vigorously in a circular manner. TABLE I. Preparations ust-J and duration of treatment Sex
Age
Steroid preparation
I 2
F F
38
3 4 5
F F M F M
S>~nalar Forte Betnovaic Scalp Application Synalar Forte Synalar Forte Synalar Forte SvTiaUr Forte Synalar Forte S>iialar Gel
Case
6 7 8
M
13 21
3« 25 24
49 39
Duration ol" use when regrowth noted (weeks) 10
8
S II
8 z6 i«
6
Circular rubbing Denied Admitted Denied Admiitcd Possible Possible Admitted Admitted
All ofthe lesions subsequently rcgrew hair in the central area and eventually disappeared (Figs i, 2 and 3). We wonder if this peculiar regrowth pattern is an artefact due to the unconscious tendency to rub in a circular manner with maximum concentration at the edge of the lesion, or whether it is related to the ripple like spread of disease activity. ACKNOWLEDGMENT We would like to thank the photographic department of St John's Hospital for Diseases of the Skin for the illustrations. „,
.
„
. ,
Westminster Hospital, London SAV.i. St George's Hospital, London S.W.i.
R.S.H.TAN
T.J.DELANEY
234
Correspondence REFERENCES
ABELL, E . & MUNHO, D . D . (T973) Intralesional ireatment of alopecia areata with triamdnolone acetonide by jet injector. Brirish Journal of Dermatology, 88, 55. ECKERT, JOANNA, CHURCH, R.E. & EBLING, F.J. (1968) The paihogenesis of alopecia areata. British Journal of Dermatology, 80, 203. J J.J. & KLIGMAN, A.M. (1972) Treatment of alopecia areata with steroid solution. Archives of Dermatology ^ 106, 924.
FIGURE I. Patient No. 7. Circular regrowth in characteristic pattern after application of steroid for 16 weeks.
2. Sanic ^rca as Fig. i, 8 weeks later.
Correspondence
235
FIGURE I. Same area as Fig. i, ro weeks later.
Book Reviews Proceedings of the 14th International Congress of Dermatology, Padua/Venice, 22-27 1972. F.FLARER, F.SERRI and D.W.K.COTTON (Ed.) (1974) Amsterdam: Excerpta Medica. Pp. 1008, illustrated. Price £44.80 The proceedings of the Venice International Congress cover virtually all aspects of dermatology. They should therefore, and do, contain something of value for everyone, albeit somevi-hat diluted. The list of contents alone runs to 22 pages. The papers which succeed most are cither those where a world authority highlights the salient problems of some larger prohlem, without attempting to cover the whole field, or the shorter papers which convey only a single simple message. For example, the review of immimotherapy of malignant melanoma by Kopf brings together material from many sources. It is now generally accepted that International Congresses are not the forum where new material is presented, and virtually nothing emerges that has not appeared in print elsewhere. However, few can be aware, for instance, of the distinctive acral psoriasiform eruption described by Bazex, Dupre and Christol, which so far has been associated with a systemic carcinoma as regularly as is acanthosis nigrigans. Many of the genodermatoses described are also likely to be unfamiliar. The papers are all written in English, a remarkable tribute to somebody's industry. Some authors have been content to allow their original summary printed before the Congress to be published, and several have failed to provide even a key bibliography. The editors and publishers are to be congratulated on marshalling together so attractively such unwieldy material, much of which was perhaps more suitable for verbal than written presentation. Most individual dermatologists will probably feel that the average amount of useful information per page makes this book too expensive to buy, but will nevertheless find that there is much of value in it and they will want access to it in libraries. It can be appreciated why the organizers of the next congress are apparently considering alternative ways of recording the proceedings. R.H.CHAMPION
