5 fluorouracil for reducing scarring
mike
up next time to the med-library? We cannot let this important clue go
unnoticed.What's occurring here? Why? How?
1: Semin Cutan Med Surg 2000 Dec;19(4):287-92 Related Articles, Books,
LinkOut
Laser treatment of hypertrophic scars, keloids, and striae.
Alster TS, Handrick C.
Washington Institute of Dermatologic Laser Surgery, DC, USA.
The successful use of the 585-nm pulsed dye laser for the treatment of
hypertrophic scars has been well established over the past decade.
Although 5 years ago this treatment option might have been considered as a
viable choice only after all other methods failed, it is now generally
recognized as an excellent first-line treatment option. Early scar
treatment with pulsed dye laser irradiation effectively prevents scar
formation or worsening and yields a better and more prolonged clinical
improvement. The concomitant use of corticosteroids, 5-fluorouracil, or
other treatments is proving to be of particular importance in reducing
scar bulk and symptoms of more proliferative scars. Although optimal
management for keloids and striae has yet to be determined, pulsed dye
laser irradiation will no doubt continue to play a role in their
treatment.
Publication Types:
Review
"""""""""""""""""
JAMA 1977 Sep 12;238(11):1149 Related Articles, Books, LinkOut
Male pattern alopecia regrowth following topical fluorouracil therapy.
Rietschel RL, Madorsky DD.
Publication Types:
Letter
PMID: 578157 [PubMed - indexed for MEDLINE]
--------------------------------------------------------------------------
------
Bryan Shelton
>Would anyone consider picking this up next time to the med-library?
They're both now on my list...
Bryan
mike
COOL!
Peter H. Proctor
>From: mike <emka...@dodgenet.com>
>Subject: 5 fluorouracil for reducing scarring
>Date: 13 Aug 2001 07:32:56 GMT
>Is reversing scarring the key?
Don't think there is any "key" per se. But fibrosis does seem to be
important, particularly in the final stages of follicular degeneration.
Would anyone consider picking this>up next time to the med-library? We cannot
let this important clue go >unnoticed.What's occurring here? Why? How?
I do a fair amount of laser treatment. Yes, green-light lasers (
typically, the 585 nm pulsed dye or the frequency-doubled YAG at 532 nm ) do
shrink scars pretty well.
These are the same green light lasers that are used to zap red
stuff, e.g. blood vessels such as in port-wine stains, etc. The
mechanisms is that green light is preferentially absorbed by hemoglobin
in blood vessels, zapping the blood vessel either by thermal mechanisms or
by "exploding". Without the blood vessel nutrients, the scar shrinks.
Works pretty well, although only a small amount of shrinkage can
be achieved every session due to relatively poor penetration of the light.
Typically there is a bruise and/or a little blistering that clears up quickly.
Unfortunately, this is not applicable to diminishing fibrosis in
balding follicles, where the last thing you want is to zap blood vessels.
Peter H Proctor, PhD, MD
http://www.drproctor.com
Bryan Shelton
>>>Would anyone consider picking this up next time to the med-library?
>>
>>They're both now on my list...
>
>COOL!
Ok, Mike, I was at the library tonight and I got both of those articles
for ya! I'll report on the other one some other time, but for now I will
give you the more interesting one, which is: "Male Pattern Alopecia
Regrowth Following Topical Fluorouracil Therapy", which was only a letter
to the editor of JAMA, Sept. 12, 1977 -- Vol 238, No. 11. I'm going to type
out every single word of this letter for you, even the references at the end,
because I have to admit that this IS a very interesting little article! The only
thing I can't reproduce is the picture of their subject that they include; this
is a photo of a guy that's pretty bald in about the front 2/3 of his crown.
But you can see in the picture that there's an area of growing hairs in the
middle of this bald area (it kinda reminds me of the growth that you can see
on Waseda's new pictures, if that helps any). The numbers in parentheses
are for the references at the end:
---------------------------------------------------------------------------
To the Editor. --- We wish to report a patient thought to have male pattern
baldness for ten years; He began to regrow terminal hair after his scalp was
treated with fluorouracil for actinic keratosis.
Report of a case. -- The patient is a 45-year-old man who had been bald in
a fronto-parietal distribution for ten years when seen on Sept 27, 1976,
at the Dermatology Clinic, Brooke Army Medical Center. He had multiple
actinic keratoses of the scalp and was treated with 2% fluorouracil (Efudex)
solution followed in ten minutes with 0.5% triamcinolone acetonide cream
daily (1). When seen on Oct 18, 1976, after 21 days of treatment, a confluent,
brisk erythema and edema engulfed the scalp, nose, and temples. The
fluorouracil therapy was discontinued, and the reaction subsided after three
weeks of 0.5% triamcinolone therapy. The patient was not seen again until
March 10, 1977, when he returned specifically to say thanks for the regrowth
of hair he was experiencing. The entire area of balding now consisted of
terminal hairs of uniform length (1.5 cm). The patient noticed the regrowth
of hair as the erythema subsided from his fluorouracil treatment. The length
of his new terminal growth was compatible with the time interval of the
fluorouracil reaction, and the uniformity suggested that some event had
synchronized the hair follicles (Figure). The patient's serum cortisol,
17-hydroxysteroid and 17-ketosteroid levels were normal. Open patch tests
to 2% fluorouracil solution, closed patch tests to 0.25% and 0.5% fluorouracil,
and 25% propylene glycol were negative.
Comment. -- The patient's hair growth has continued, and we cannot adequately
explain it. Occasionally alopecia areata may mimic male pattern baldness (2),
and regrowth of alopecia areata has been stimulated with dinitrochlorobenzene
(DNCB) sensitization (3). If our patient in fact had alopecia areata misdiagnosed
as male pattern baldness, then a contact sensitivity to fluorouracil might explain
the regrowth of hair. However, we did not demonstrate such a sensitivity. We are
not involving actinic keratoses as the cause of the original hair loss, as they
developed subsequent to his balding.
The prolonged treatment with potent topical steroids deserves comment.
Orentreich et al (4) reported the failure of local injections of corticosteroids
to induce hair growth in 50 cases of male pattern alopecia. Topical cortico-
steroids were unsuccessful in 40 additional patients with various causes
of alopecia (4). A restoration of the normal perifollicular vascular architecture
accompanies both the spontaneous regrowth and corticosteroid-induced
regrowth of hair in alopecia areata (5). It is possible that the prolonged use
of a potent topical steroid induced a normalization of the vascular pattern,
but this seems unlikely in view of the study of Orentreich et al (4).
Regrowth of male pattern baldness has been reported following the use
of testosterone propionate (191:521, 1965), but this was not confirmed
(204:451, 1968). We are curious whether the readers of The Journal have
observed any similar reactions after fluorouracil or topical corticosteroid
therapy.
The opinions or assertions contained herein are the private views of the
authors and are not to be construed as reflecting the views of the Department
of the Army or the Department of Defense.
Robert L. Rietschel, MD
David D. Madorsky, MD
Brooke Army Medical Center
Fort Sam Houston, Tex
1. Breza T, Taylor JR, Eaglstein WH: Noninflammatory destruction of actinic
keratosis with fluorouracil. Arch Dermatol 112:1256-1258, 1976.
2. Maguire HC: Diseases of the hair, in Moschella SL, Pillsbury DM, Hurley HJ
(eds): Dermatology. Philadelphia, WB Saunders Co, 1975, p 1209.
3. Dunaway DA, Rosenberg EW, Drake L: Alopecia Areata. Arch Dermatol
112:256, 1976.
4. Orentreich N, Sturm HM, Weidman AI, et al: Local injection of steroids
and hair growth in alopecias. Arch Dermatol 82:894-902, 1960.
5. Popchristov P, Konstantinov A, Obreshkova E: The blood vessels of the
scalp in patients with alopecia areata before and after corticosteroid therapy.
Br J Dermatol 80:753-757, 1968.
mike
>On 13 Aug 2001 08:08:34 GMT, mike <emka...@dodgenet.com> wrote:
>
>>>>Would anyone consider picking this up next time to the med-library?
>>>
>>>They're both now on my list...
>>
>>COOL!
>
>Ok, Mike, I was at the library tonight and I got both of those articles
>for ya!
Thanks I appreciate you getting this,I hope some more information
comes from this.
He regrew hair after discontinuing fluorouracil,this is normal in people
without mpb.But I'm sure you're thinking the same thing,mpb should've
still be a negative to even prevent this from occurring in the first
place.What could've fluorouracil done or not done?
A list of possibilities to work from(entertaining ideas from anyone
would be most helpful here):
1)did fluorouracil alter some genetic code in the hair follicle or force
repair mechanisms to 100% capacity which might be for the
good? Injuring for the good? Pickart talks about this with retinoic acid
and wrinkles on his website What makes me say this? I know of people
after discontinuing their chemo drugs that their hair comes back in even
thicker than before sometimes curly when it wasnt curly before and even
heard of graying reversed.
2)is fluorouracil effective at scar removal? Coincidentally they
used a corticosteroid which is also somewhat effective at removing scars(
as mentioned in the other abstract you're looking at)
so this guy might've been getting the double whammy in that regard.
As you point out corticosteroids(Orentreich) arent topically effective by
themselves perhaps both were needed in this guys case?
Further questions:
Can we safely use a pulsed fluorouracil/corticosteroid(F/C) combination
topically or is there systemic leakage? I suppose you could hit
the scalp maybe for a 3 week blast as they did without risking much.
He still had hair 5 monthes past the end of the treatment.This is
unusual in itself as you discontinue whatever hair growth agent and
you're likely to have massive loss 3 monthes or less from cessation
of treatment.How long does the treatment last before the genetics
of mpb start to come back or what if(dreaming) mpb didnt come back at all?
If f/c combination is not plausible then are there similar drugs
which treat actinic keratoses more safely or even scarring effectively?
I'm sure as Dr.P points out sodases do reverse scarring somewhat,but
are they effective enuff on their own? Perhaps it took the synergy(
I'm guessing) of both agents(F/C) to reverse scarring to a measurable
result(hair) level.
Thanks for posting this.I wish we could get followup on this guy to
see what's transpired since this happened.
Manelessrjd
>Date: 8/13/01 12:32 AM Pacific Daylight Time
>Message-id: <9l7vr8$b3s$3...@ins21.netins.net>
Mike,
What are the best things available to reverse the fiboris/scarring? I
presently use tricomin and minoxidil to do that, but as you yourself said they
are only a little effective at it. Are there things that are more effective at
it?
BeverlyOmasta
from some odd pathway....tom
Manelessrjd
>From: beverl...@aol.com (BeverlyOmasta)
>Date: 8/25/01 1:58 PM Pacific Daylight Time
>Message-id: <20010825165855...@mb-mp.aol.com>
>
>maneless:::i know this may sound crazy,but NEOSPORIN apparently reduces scars
>from some odd pathway....tom
I think this stuff can be dangerous very easily, but I'm not sure. We
definitely need to deal with fibrosis/scarring.
mike
Maneless I'm even wondering whether you have fibrosis to any degree.
If you said after 2 weeks with flutamide you were noticing regrowth,
then how could there be any? As Kev said most likely there will be
a wide spectrum of fibrosis amongst individuals,some with none to some
with alot.Perhaps the difference in the two separates the responders
from non-responders?