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John Cabrera

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¨  What are the side effects of alopecia treament?
  Is alopecia universalis hereditary?
  What does it mean to "take the Mickey"?

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I have been suffering with the same type of alopecia you have since I was 6.  I am now has made me very strong and I am now very comfortable with my 18 and it conditionof medication and my hair has just recently started to come in.  I .  I am on a lot am very excitedstarted cortisone shots.  I was wondering what the nasty side .  I just effects are.

ANSWER from John Cabrera on 12 May 2003:
Thank you for taking the trouble to write to me.

I am sorry you have had to put up with alopecia for so long and from such an early age.  But, even though I don't know you, I am proud of you for your courage and strength.  I have met a number of young women who have had the same experience as you and they too have generally been cheerful and positive people.  People like that, people like you make me feel great.  That is a rare gift.

As you know, I am not entitled to give medical advice.  So you should consult your doctor or other doctors (if you want second and third opinions.  You say you are on a lot of medication and, although I cannot deduce this from your email, it may be that your treatment covers more than one condition or is part of a complex treatment regime.  I have based the following on my own experience, articles from the internet and Encyclopaedia Britannica.  You can look at many of these sources yourself, Useful hyperlinks are: National Alopecia Areata Foundation www.alopeciaareata.com and www.keratin.com.

I understand that people who have had patchy alopecia areata for less than one year are likely to respond well to treatment.  But when alopecia areata, and its more severe manifestations, has persisted, with or without treatment, for more than two years the prognosis is much poorer.

The extent of side effects from steroid treatment is, I believe, related to strength of doses and the way in which these are applied.  So, with topical treatments (creams, lotions, etc.), side effects would be the least but could still include folliculitis (inflammation of the hair follicles that can be persistent, but not irreversible), acne outbreaks, local skin atrophy where the cream is applied and very occasionally hypertrichosis (excessive, abnormal hairiness that may be localised or covering the entire body).

With treatment involving localised injections, you can suffer from pain from the injections and atrophy of the skin around the injection site.  This atrophy is usually reversible unless the region has been repeatedly injected over time.

With all treatments there is a risk of systemic absorption if doses are too high and/or too frequent and more serious side effects are likely to follow.  The most intense treatments use systemic absorption.  Such treatments are usually taken orally or can be injected into a muscle.  After oral or injected administration of a drug, absorption into the bloodstream occurs in the stomach and intestine.  The rate of absorption depends on factors such as the presence of food in the stomach, the particle size of the drug preparation, and the acidity of intestinal contents.  Absorption is a quick process.  Serious circulatory and respiratory effects can occur with systemic drug treatment.

Systemic application of steroids is the most powerful form of corticosteroid treatment and, so my own doctor has told me, is generally highly effective in producing hair re-growth.  But, systemic use of steroids has been shown not to alter the long-term prognosis for alopecia.  Systemic applications generally promote temporary re-growth of hair with a subsequent relapse when the treatment is stopped.  For this reason, and the need to get people off systemic steroid use as soon as possible, this form of treatment is frequently used in conjunction with something else to help maintain the re-growth when systemic steroid treatment is stopped.

Systemic corticosteroid treatment is usually only a treatment of last resort because of the potential for serious side effects.  Systemic treatment is generally limited to just a few weeks before it must be stopped.  Side effects include weight gain, acne outbreaks, menstrual problems, mood swings, migraines, cataracts and other eye complications, stunted growth in children, osteoporosis, high blood pressure, and/or diabetes.  These are all unpleasant and high blood pressure, in particular, worries all doctors and is a known risk factor for heart disease and early death.

I know that people with alopecia universalis are capable of re-growing hair even after many years of hair loss.  I get occasional re-growth on my scalp and other parts of my body but the re-growth never makes any real progress.  A few years ago, I visited a dermatologist to see if the re-growth, combined with corticosteroid (or any other) treatment would be worth trying.  However, he was quite unwilling to prescribe any medication.  He took the view that, if I was coping well and feeling healthy, there was no point in interfering with my immune system.  Steroid treatment would eventually have to be discontinued and the baldness would return.

This is, I imagine, a rather disappointing answer but please do not rely on what I say.  I have no doubt that a cure, that does not produce nasty side effects, will one day be found.  But it may take a long time.  Your doctor will advise you.  Again, you are perfectly entitled to obtain other medical opinions and I would urge you to do that.  You should not start or stop any medical treatment without medical supervision.

If you want to write to me again, please do so.  And, I would be happy to hear of your progress. More than anything, I wish you happiness and a long healthy life.

Best wishes.


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I am a male in his late-twenties who has had alopecia universalis since 1998, when I lost all my hair within 4 months.  After a pretty tough mental struggle I managed to accept the fact that I have AU.  Now I wish to get married.  Will my children will also inherit this problem?

ANSWER from John Cabrera on 29 April 2003:
I recognise you are a young man and that, having lost your hair only five years ago, you may still feel uncertain of your self-image and the way others perceive you.  With time, I am certain you will increasingly accept your condition (as, no doubt, you are already discovering) and, as you gain in confidence in your self-perception, so will those around you.  It is a matter of joy that you are planning soon for marriage and I wish you and your wife much happiness and fulfilment.  You and your wife are hoping for a family and your question is the first I considered before my wife and I embarked upon starting a family.

A qualification I must make is that I am not an expert in the aetiology of alopecia and I cannot tell you what the statistical likelihood is that any of your children will suffer from the condition.

I suspect alopecia is hereditary.  But that does not guarantee your children will exhibit the condition.  I have two sons aged 15 and 18, neither of whom has shown even the slightest hint of alopecia areata.  That said, my brother, in his mid-forties, has patchy facial hair.  This is alopecia areata.  Not a big problem, as he is clean shaven but, undoubtedly, a sign the condition is present.  A 50-year old friend of mine, who has normal hair, has a father who suffers from alopecia universalis.  My friend has never shown any signs of alopecia other than normal male pattern hair loss.  So, from my limited personal experience, I have not seen a transfer of alopecia universalis from one generation to another.

But, rather than attempting to give you false assurance, please permit me to say you are fortunate to be about to explore the power of love, between you and your wife, to create a family.  You and your children will face many challenges as they grow up and in their adulthood.  Your feelings about your children's risk of losing their hair and your knowledge of all the other hardships of life should not spoil your hopes for an exciting and happy family life.

So, I shall limit my last thoughts to congratulations and warmest wishes for you, your wife and your future family for many years of happiness and prosperity.

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What does it mean to say "take the mickey"?

ANSWER from John Cabrera on 11 February 2003:
I had never before considered the origin of TtM though my first guess was that it was cockney rhyming slang.  What is that?  I hear you ask.

A cockney is a person born in central London - specifically, within the sound of the bells of the church of St Mary-le-Bow (Bow Bells).  Some people believe that members of the London underworld concocted cockney rhyming slang in the 19th century as a means of arcane communication.  This was useful when plotting some nefarious deed that might interest the police.  Today, many people use rhyming slang either unwittingly or for humorous effect.  The art of rhyming slang is often not to complete the rhyme when using a particular expression.  Here are some examples:

A "butcher's" means a "look".  The complete term would be "butcher's hook" to rhyme with "look".

A "dog" is a "'phone" from "dog and bone": "'phone".

"Loaf" means "head" - I'm sure you can see why - "Use your loaf" is something my grandfather often said to me.  And my father, and my "trouble"!  That means "wife", by the way, as in "trouble and strife".

These are all clean examples; as you might imagine, the scope for rudeness is vast.

So, is TtM cockney rhyming slang? Chambers Dictionary gives the following definition:

mickey: noun. take the mickey or take the mickey out of someone colloq to tease or make fun of them.  ETYMOLOGY: 1950s.

True enough but not very interesting.

I found a dictionary of British slang on the Internet that gives an explanation for the term "Mickey Mouse":

Adj. 1. Stupid looking, comical.  E.g. "I'm not wearing that in public!  It's a Mickey Mouse hat."  2. Second rate, of poor quality, cheaply made.

Noun. A person from Liverpool.  Rhyming slang on "scouse".  Also Mickey Mouser rhyming on "scouser".  Cf. "scouse" and "scouser"

But this still does not hit on the meaning of TtM.  At last, I found the following definition.  Although it catches the likely rhyming connection (which is on the rude side), it does not really ring true:

Take the mickey - make fun of.

Mike Bliss, sometimes shortened to Mike, is Cockney rhyming slang for "piss"; it is not known who he was or even if he ever existed.  To take the mickey (Mickey being a variant of Mike, short for Michael) is a euphemism for "take the piss" (jeer at, deride, deflate - perhaps from the idea of deflating the bladder).  The meaning is kinder too.

So there you have it.  TtM is almost certainly a rhyming slang version of a somewhat ruder expression.  However, I don't really think it's all down to some long forgotten fellow called Mike Bliss!

If you like this kind of stuff, I have just found a good website:

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Last Updated:
12 July 2003

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