Paleodermatology

Evolution acts through a combination of four different drivers: (1) mutation, (2) selection, (3) genetic drift, and (4) developmental constraints. There is a tendency among some biologists to frame evolution as the sole result of natural selection, and this tendency is reinforced by many popular texts. “The Naked Ape” by Desmond Morris, published 50 years ago, is no exception. In this paper I argue that evolutionary biology is much richer than natural selection alone. I illustrate this by reconstructing the evolutionary history of five different organs of the human body: foot, pelvis, scrotum, hand and brain. Factors like developmental tinkering, by-product evolution, exaptation and heterochrony are powerful forces for body-plan innovations and the appearance of such innovations in human ancestors does not always require an adaptive explanation. While Morris explained the lack of body hair in the human species by sexual selection, I argue that molecular tinkering of regulatory genes expressed in the brain, followed by positive selection for neotenic features, may have been the driving factor, with loss of body hair as a secondary consequence.

Alopecia frontal fibrosante en el varón: presentación de 12 casos y revisión de la literatura

Mankind is thought to have separated from a common ancestor shared with chimpanzees approximately 7 million years ago.1 At the time, among our ancestors was a group that decided to come down from the trees to live in the savanna as desertification of Africa's forests progressed. Although the term “ape-man” was used for early mankind who walked on two feet, improvements in the precision of dating methods and excavations from the latter half of the 20th century made it clear that many types of human species coexisted. Thus, the term “ape-man” is now only rarely used. Bipedalism was likely something attempted by many groups, and although many theories exist, the underlying reason for this transition is unclear.2 However, the advantages are clear – it enabled viewing vast distances and the use of hands to carry food, and ultimately led to the expansion of brain size. Interestingly, it took our ancestors an additional 4 million years to expand their brain size. This evolutionary delay might have been caused by climate changes in Africa. The progressively drying climate led to reductions in forestland, and our ancestors who lived on the plains were subjected to a new type of natural selection pressure, causing changes in their physique and behavior. One possible reason that orangutans remained in the trees when transported to Asia by continental drift was that although Africa and the Northern hemisphere began to dry and cool from approximately 30 million to 2.5 million years ago, Asia's forests in the tropical regions remained intact. Evidence of brain size expansion and the use of tools can be found from approximately 2.5 million years ago. Mankind at this stage is referred to as Homo habilis or Homo rudolfensis. The concept of pre-adaptation refers to gradually altering physique in advance so that it works to one's advantage once subjected to a particular environment. For instance, the advantages of walking erect are thought to have played an important role in the evolution of mankind much later; that is, approximately 2.5 million years later. The expansion of brain size also brought about a revolution in food energy, which accompanied the use of stone tools – the ability to ingest high caloric and nutritious meat products. Although they were “meat-eating” and hunted herbivorous animals on occasion, their meat supply likely came from food left over by carnivorous animals. In addition to increasing meat-eating efficiency, the expansion of brain size was accompanied by acquisition of modern man's physique, an expanded range of activity and loss of body hair. Although many human species remained in Africa, one group, the Peking man or Java man (also known as Homo erectus) moved to Eurasia approximately 1.8 million years ago in an event referred to as the first African exodus. At least one group of Homo erectus began using fire, a monumental event in mankind's history. Homo erectus existed until 250 000 years ago. We enter the age of modern man from approximately 200 000 years ago. The Neanderthals were another species of man that coexisted with modern humans during this period. This period saw the use of symbols, language and original art-forms. One group of modern humans left Africa approximately 100 000 years ago, and eventually adapted to all global environments in an event famously known as the second African exodus. Many terrains were conquered, including grasslands, deserts and mountains, and humans began living under various climates (tropical, temperate and polar). The conquering of various terrains is evidenced by the existence of Eskimos in polar regions, Bushmen in the deserts, Pygmies in the tropical rain forests, and Tibetan highlanders. The spreading of humans was particularly fast, with humans reaching Europe, Asia, North and South America, and Australia within the span of tens of thousands of years. Mankind at the time formed small nomadic groups and lived as hunter-gatherers. From a modest population of approximately 100 000 about 1 million years ago, the global population dramatically increased to 500 000 about 200 000 years ago, and further to approximately 10 million with the advent of agriculture about 10 000 years ago.3

Background:Vasomotor symptoms such as hot flashes and sweating, typical of the menopausal syndrome in women, are less commonly seen in males after loss of testicular function. We present an interesting case of a middle-aged man who was evaluated for progressive episodes of hot flashes, sweating and flushing and was eventually diagnosed with pituitary macroadenoma causing secondary hypogonadism. Clinical Case:A 59 y.o. male was referred endocrinology clinic with intermittent episodes of hot flashes and sweating over the last 2 years. He has had progressive episodes of feeling warm, associated with some flushing, and then transient profuse sweating, usually lasting no more than several minutes. His only other medical problem has been chronic recurrent gout requiring Allopurinol 300 mg daily, Probenecid 500mg twice daily and Colchicine 0.6mg twice daily to prevent gout attacks. He denied any headaches, palpitations, feeling tremulous, no vision symptoms, no breast enlargement or loss of body hair, no constipation or diarrhea. Physical exam was significant for paucity of facial and body hair, and no evidence of gynecomastia. He had an episode in the office visit where he became flushed, diaphoretic, his blood pressure was 120/80 and he did not have tachycardia. Lab studies revealed Prolactin= 19 (n= 2-18 pg/dL), Cortisol 8.6 (6-27 ug/dl), Total Testosterone = 22 (n=250-1100 ng/dL), LH = <1 (n=1.5-9.3 mlU/ml), free T4 0.6 (ref 0.6-1.6 ng/dl) with TSH 1.51 (ref: 0.34 -3.00 uIU/ml), IGF-1 = 49 (34-232 ng/dl), Total metanephrines urine 654 ( 233-716 (Normotensive)), VMA = 3.6 (<8.0 mg/24 h) suggestive of secondary hypogonadism with elevated prolactin and low LH. MRI of the brain revealed mass of the sella extending into the suprasellar region measuring up to 2.0 x 2.3 x 1.8 cm. He then underwent endoscopic transsphenoidal resection of pituitary tumor and histopathology revealed null cell adenoma with widespread oncocytic changes consistent with an oncocytoma. On follow up visit in 1 month, his debilitating sweats have diminished significantly but not disappeared. Conclusion: Hot flushes are common in men who are acutely hypogonadal after orchiectomy or testicular injury, but it is an unusual symptom in patients with hypogonadism secondary to pituitary tumors. There are case reports of pituitary adenoma diagnosed through evaluation of sexual dysfunction and frequent hot flashes. This case illustrates the importance of considering broad etiologies when evaluating new onset hot flashes in middle-aged men, especially in the absence of other presenting features of pituitary macroadenoma and when symptoms of hypogonadism (like erectile dysfunction, low libido, impaired concentration and fatigue) go unreported to physicians.

Alopecia areata is a non-scarring alopecia that can present as patches of hair loss (areata, AA), complete scalphair loss (totalis, AT) or complete scalp and body hair loss (universalis, AU). It is an autoimmune disease mediated via CD8+ T-cell activation and NKG28 signaling targeting the hair bulb. Previous reports indicate that systemic treatment with methotrexate (MTX) benefits patients with AT or AU when used alone or with systemic corticosteroid administration. This study evaluates the utilization of MTX as a treatment modality in patients with alopecia areata who have greater than 50% hair loss.

Introduction: Alopecia areata has different clinical presenting patterns, it may starts with a self limited single or separated patches on the scalp or any area of the body and progressing to complete scalp hair loss or complete body hair loss. 0bjective:Determination prevalence of alopecia areata with clinical configurations of patients in this area and its comparison with similar studies in other parts of the world that is the base and its localization to scalp or body in relation to skin color and nail ridging or cryptic dental infection or carries. Method: 952 patients with alopecia areata were studied who has been found among of 25186 new patients in this study that had been referred from all around the Kerman a province of Iran, as out patient during 3 years by the major points of age, sex, family history, extent percent of involved area & history of any determined infection such as nail ridges and dental caries or infections who were variables that has been evaluated in this study. Results: 3.78% of all new dermatology patients had alopecia areata. Family history was seen in 3.6% of patients and male to female ratio was 2.6 & the commonest clinical patterned were either round or oval types. Hair loss configurations in 252 patients (26.5%) were only restricted to scalp, in 216 cases (22.7%) to body, and in 414 cases (50.8%) was seen in both scalp & body (bipolar) alopecia areata. Bipolar type of alopecia areata was seen mostly in the first 3 decades of life which shows a significant difference in compare to the other configurations (p<0.01). Conclusion: Prevalence of alopecia areata between new dermatologic patients during 3 years was as 3.78%. Body hair loss (bipolar type) in males and a the first 3 decades of age were significantly more than females and those who were in upper 3 decades of age respectively.

Alopecia areata is a common cause of non-scaring autoimmune hair loss, associated with substantial psychosocial burden. Alopecia areata is an autoimmune disease in which loss of immune privilege in hair follicles leads to local hair follicle-associated inflammation. A chronic disease with uncertain course that is estimated to affect 2% of people over their lifetime, alopecia areata can present with a range of clinical features, from a single small round patch of hair loss to full scalp and body hair loss, and is associated with atopic, autoimmune and psychological comorbidities. Alopecia areata also has a major negative impact on quality of life, with a greater mental burden than physical burden. Since the 2010s, advances in understanding of disease pathogenesis have led to the identification of inflammatory pathways that can be successfully inhibited to produce substantial clinical responses. The therapeutic landscape has been transformed, with FDA approval of the first treatment for adults with severe alopecia areata in 2022 and for adolescents with severe alopecia areata in 2023, with multiple investigational treatments currently in phase II and phase III clinical trials.

Patients and partners lack knowledge of androgen deprivation therapy side effects

The role of zinc in liver cirrhosis

Background:Alopecia areata (AA) is a chronic autoimmune disorder characterized by patchy loss of hair from scalp, beard, eyebrows, or rarely even body hair. Rarely, the disease can be widespread and severe leading to loss of entire scalp and body hair causing apprehension and psychological stress in patients. Management of such cases is equally difficult with the available options of topical and systemic immunosuppressant. Tofacitinib, JAK3 inhibitor, is emerging as a promising drug for the management of severe and resistant cases of AA/totalis/universalis.Objective:Our study aims to show the effectiveness of oral tofacitinib in the treatment of alopecia universalis (AU).Methods:Six patients diagnosed with AU/alopecia totalis duration of disease 6 months–15 years refractory to other treatments were selected and were started on oral tofacitinib 5 mg twice daily up to 10 mg BID and were followed up every 4 weeks. The efficacy was measured by hair regrowth using photographic assessment, Severity of Alopecia Tool score, and physical examination. Patients will be followed up for 6 months after stopping treatment for assessing disease relapse.Results:All our six patients showed dramatic response to oral tofacitinib. Patients were followed up every 4 weeks, and results were assessed. Significant hair regrowth was evident in all the patients by the end of 12 weeks. Currently, four of our patients are on oral tofacitinib 10 mg BID and are under follow-up. There was no relapse in one patient after stopping drug for 4 months. Another patient started developed AA patches in the eyebrows within 2 months of stopping tofacitinib. Acneiform eruptions were seen in two patients which were managed with topicals.Conclusion:In our patients, tofacitinib successfully alleviated AU in the absence of significant adverse side effects. We recommend that further controlled studies be required to establish safety and confirm efficacy.

Serum level of vitamin D in patients with alopecia areata

Alopecia areata (AA) is an autoimmune nonscarring alopecic disorder, which presents with varying amounts of hair loss, ranging from focal patchy loss to entire scalp and body hair loss. Treatment of AA is a challenging issue within dermatology practice. Although many treatment options are present, response to medications remains unsatisfactory, especially in severe and recalcitrant cases. In this study, we present a case of treatment-resistant AU, which was successfully treated by the combination of tofacitinib and oral minoxidil.

A 69-year-old postmenopausal woman consulted for frontal hair loss for two years. She had started menopause at the age of 50 years old and had been taking bisphosphonates for her osteoporosis for two years. Her clinical history, including gynecological data, was otherwise negative. Anamnestic data ruled out the possibility of traction alopecia. Dermatological examination revealed a Fitzpatrick skin type III. She had a linear frontotemporal recession with perifollicular erythema, lonely hairs on the frontal region, and scarring alopecia ( Fig-ure 1). The patient had a total loss of eyebrows but she did not have body hair loss. There were no other skin or mucosal abnormalities. Thyroid hormone function was also normal. Dermoscopy with a non-contact polarizing FotoFinder der-matoscope x20 (FotoFinder Systems, Inc, Bad Birnbach, Germany) revealed perifollicular erythema and very mild perifollicular scaling in addition to hair shaft dystrophy and broken hair. Furthermore, dermoscopy noted the presence of white dots coexisting with irregular white and pink areas devoid of hair follicular openings ( Figure 2 ). No prior topical treatment was used before our consultation. A 4 mm scalp punch biopsy from the frontal hairline was performed. His-

Alopecia totalis (AT) with body hair loss is the most severe type of alopecia areata (AA). The ability to develop hair is suggested to be poor in such severe AA, because AT does not respond to corticosteroid pulses and immunotherapy using squaric acid dibutylester (SADBE) or diphenylcyclopropenone (DPCP). The purpose of this study is to assess the possibility of hair regrowth in AT with body hair loss. Ten patients with AT who did not respond to topical immunotherapies, received triamcinolone acetonide (TA) injections. Undiluted or 2-fold diluted solutions of TA were prepared and 0.1–0.2 mL of either of the two solutions was administered to each patient. In total, 2 mL of the selected solution was injected monthly into each area. In cases where vellus hair developed after the injections, we restarted the immunotherapy using SADBE or DPCP and continued the therapies for more than half a year. The development of vellus hair after TA injections was defined as a good response. Complete response rate to the topical injection of TA was 10% (1/10), however the partially good response rate was 60% (6/10). The good responders showed the anagen stage of hair follicle after TA injections. Furthermore, the complete responder to TA showed susceptibility to the subsequent immunotherapy and more regrowth of hair was seen. Even if patients with AT have suffered for a prolonged period since onset, it is possible to recover the hair cycle if they show susceptibility to intralesional corticosteroid and subsequent immunotherapy.

Lay Summary Alopecia areata (AA) is a long-term condition that can occur in both children and adults. AA can appear as patches of baldness on the scalp. Sometimes, nail growth is also affected. Hair on other parts of the body may also fall out, such as the beard, eyebrows and eyelashes. Alopecia totalis is the name for total loss of scalp hair. Alopecia universalis is complete loss of scalp, facial and body hair. This is the second version of the guideline. The British Association of Dermatologists gathered a group of experts in managing people of all ages with AA. The group consisted of eight consultant dermatologists, one dermatology specialist registrar, one general practitioner, one psychologist, two people with AA and a team with expertise in preparing guidelines. This group of experts reviewed relevant studies published until 11 July 2025. Using the evidence, the group produced recommendations using rigorous standards for guideline development. The guideline development group produced 56 recommendations for management of people with AA. They also made 9 recommendations for future research and suggested 11 audit points for hospitals. Based on the guideline, a patient information leaflet is also available on the British Association of Dermatologists’ website (https://www.skinhealthinfo.org.uk/condition/alopecia-areata).