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Notes: Background  It has not been conclusively established that female pattern hair loss (FPHL) is either due to androgens or responsive to oral antiandrogen therapy.Objectives  To evaluate the efficacy of oral antiandrogen therapy in the management of women with FPHL using standardized photographic techniques (Canfield Scientific), and to identify clinical and histological parameters predictive of clinical response.Methods  For this single-centre, before–after, open intervention study, 80 women aged between 12 and 79 years, with FPHL and biopsy-confirmed hair follicle miniaturization [terminal/vellus (T/V) hair ratio ≤ 4 : 1] were photographed at baseline and again after receiving a minimum of 12 months of oral antiandrogen therapy. Forty women received spironolactone 200 mg daily and 40 women received cyproterone acetate, either 50 mg daily or 100 mg for 10 days per month if premenopausal. Women using topical minoxidil were excluded. Standardized photographs of the midfrontal and vertex scalp were taken with the head positioned in a stereotactic device. Images were evaluated by a panel of three clinicians experienced in the assessment of FPHL, blinded to patient details and treatment and using a three-point scale.Results  As there was no significant difference in the results or the trend between spironolactone and cyproterone acetate the results were combined. Thirty-five (44%) women had hair regrowth, 35 (44%) had no clear change in hair density before and after treatment, and 10 (12%) experienced continuing hair loss during the treatment period. Ordinal logistic regression analysis to identify predictors of response revealed no influence of patient age, menopause status, serum ferritin, serum hormone levels, clinical stage (Ludwig) or histological parameters such as T/V ratio or fibrosis. The only significant predictor was midscalp clinical grade, with higher-scale values associated with a greater response (P = 0·013).Conclusion  Eighty-eight percent of women receiving oral antiandrogens could expect to see no progression of their FPHL or improvement. High midscalp clinical grade was the only predictor of response identified. A placebo-controlled study is required to compare this outcome to the natural history of FPHL.

Notes: Background  Age-related reduction in hair is seen in the axillary and pubic regions as well as the scalp; however, it has not been investigated qualitatively on the scalp. Horizontally sectioned scalp biopsy is an ideal tool to investigate the impact of advancing age on scalp hair follicle density and morphology.Objectives  To examine the effect of age and follicle miniaturization on total hair count in 1666 horizontally sectioned mid-scalp biopsies from 928 women aged between 13 and 84 years with hair loss.Methods Setting:  Specialist hair loss referral clinic in a teaching hospital. Design: Analysis of data set.Methods:  All scalp biopsies were 4 mm in diameter and taken from the crown. Miniaturization was assessed by calculating the ratio of terminal to vellus-like hairs (T/V) at the mid-isthmus level and considered significant if the ratio was ≤ 4 : 1. Fibrosis was documented when present. Linear regression was used to examine the association between total hair count, age and miniaturization.Results  The average number of hair follicles per biopsy was 39·6 (SD ± 10·8). A highly significant negative association (P 〈 0·0001) was found between age and total follicle number, although the predictive value of age in total hair count was found to be small [root error mean square (R2) 〈 2%]. Controlling for T/V ≤ 4 : 1, the association was weakened, but remained significant. The relationship unconfounded by T/V ≤ 4 : 1 shows that for every additional year of ageing, 0·077 total hair follicles (0·22%) are lost per biopsy.Conclusions  Age and follicular miniaturization were found to be extremely weak predictors of total hair count in women with hair loss.

Notes: A review is given of the application of in situ transmission electron microscopy to study various processes associated with the crystallization of amorphous thin films. Solid phase epitaxial regrowth of ion-implanted silicon is compared with nucleation and growth in deposited thin films. The mechanism of metal-mediated crystallization is deduced directly from high resolution recordings, and the kinetics of tantalum oxide devitrefication are obtained. The advantages of direct in situ observation are described