Doctors and baldness: a five thousand year old challenge

The history of trichology follows a thread that continually intersects with that of the history of medicine in general. Even Hippocrates believed that the approach to baldness should be of a medical nature. This confrontation between doctors and hair loss, which has lasted for five thousand years, begins with the invocations of the head physicians in the Egyptian era and ends with the recent institution of postgraduate Master's degrees at Faculties of Medicine and Surgery. The biggest names in medicine concerned themselves with trichology beginning with Hippocrates, who dealt with the topic in his most famous work: the Aphorisms. Even the most celebrated doctors of the Roman era, such as Galen and Pliny the Elder, did not disdain considering hair loss, leaving important scientific contributions before passing on the baton to their distinguished colleagues of the Byzantine Empire. The narrative then flows through the most prestigious institutions of the Middle Ages, such as the Salerno School of Medicine and the Siena Accademia del Fisiocritici where, at the end of the 1600s, the distinguished anatomical describer Marcello Malpighi also taught trichology, and left his contribution to "Hair Science" with a fine description of the hair follicle in the pages of his Opera Posthuma. At the turn of the late Middle Ages and the early modern era, barbers formed the primordial nucleus of surgery and at the same time became the ones to concern themselves with hair loss. In the 1800s, several doctors published the first texts dealing with the anatomy and physiology of the hair and taking into account the principal forms of alopecia, but at the therapeutic level did not yet propose anything scientifically valid. Until a few decades ago trichology still lent itself to various commercial speculations. It was not until the twentieth century that the pathogenetic mechanisms of baldness were clarified in a scientific manner. With this knowledge, the pharmaceutical industry has been able, then, to develop the necessary drugs, and doctors have become willing and able to reappropriate treatments to counteract conditions that lead to hair loss.

Functional X-chromosomal mosaicism of the skin: Rudolf Happle and the lines of Alfred Blaschko

In this article, the contribution of Rudolf Happle to the understanding of X-linked skin diseases is reviewed. In 1977 he proposed functional X-chromosomal mosaicism as the genetic mechanism underlying cutaneous anomalies that were seen in a number of X-linked skin diseases such as incontinentia pigmenti or focal dermal hypoplasia. Moreover, he recognized that these cutaneous anomalies followed the lines of Blaschko and thus he could tie in the development of the lines of Blaschko with a datable embryonic event. Convincing proof for the concept of functional X-chromosomal mosaicism was later provided by his group from functional sweat studies in female carriers of the X-linked gene defect hypohidrotic ectodermal dysplasia showing again on the back of the patient a gross, fountain-like mosaic typical of the lines of Blaschko. Moreover, in the years 1977 to 1981 he recognized the mosaic pattern in a syndrome of chondrodysplasia punctata, linear ichthyosis, patchy cicatricial alopecia, unilateral cataracts, and short stature again as a functional X-chromosomal mosaic becoming manifest exclusively in women and proposed that this syndrome, which is today named after him, is because of an X-linked dominant gene defect. Finally, the puzzling molecular genetics of the Happle syndrome are reviewed. Most likely, the Happle syndrome gene is not lethal for hemizygously affected males but rather similar to the example of epilepsy with mental retardation limited to females, the gene actually spares male gene carriers.

Centennial Paper. Alopecia mucinosa. Inflammatory plaques with alopecia characterized by root-sheath mucinosis. By Hermann Pinkus, M.D., Arch Dermatol 1957

Six cases are presented which exhibit a peculiar type of follicular degeneration leading to alopecia and characterized by edema and the presence of mucin in the outer root sheath and sebaceous gland. This is accompanied by varying degrees of inflammation. The clinical lesions are sharply defined plaques which enlarge slowly and seem to be curable by relatively small doses of x-ray therapy.