My dermatoligist suggested this treatment, cortisone and salicylic acid, for my UO condition. However, I am afraid to use it. I know that both are toxic and that salicylic acid can be very irritating...and the steroid is to calm down the irritation. What I have gathered is that nobody here has experienced any success using either of these chemicals to stop eyebrow hair loss. Is there anyone who has treated their condition satisfactorily or had any positive results using this cocktail?

Hi - sorry this post is going to end up quite long but I want to put forward some ideas in it and quote the only medical journal article I have every read that talks of something helping UO.

I have UO also but unfortunately I was not diagnosed until my late 30's and by then the condition had run its course. (please note I also had atrophoderma vermiculata, KPRF and bad KP so mine is probably more on the extreme end of damage)

UO is reasonably rare and this can be seen by the small number of posters on this forum. I am really keen to see some sort of 'success' in treating this to prevent further damage and loss of eyebrow hair to ones that are younger (my 12 year old is showing signs of it so it is of real personal concern to me).

I will try and repost a picture of my eyebrow so you can see what effects UO has had with me (this may not be the same for everyone so don't think this is what your eyebrow will look like at 40!)

The only article I have found that states success with treatment is the following:

[size=7]Authors:
Layton AM , Cunliffe WJ
Br J Dermatol 1993 Nov;129(5):645-6

A case of ulerythema ophyrogenes responding to isotretinoin

Sir, We report a patient suffering from ulerythema ophyrogenes unresponsive to multiple topical therapies whose skin showed significant improvement following treatment with isotretinoin.

A 40-year-old woman presented in summer 1989 complaining of increasing roughness of the facial skin associated with reddening and soreness in the affected areas. She had first noticed the problem as a teenager. Initially, the area most significantly affected was around the lateral eyebrows and upper cheeks. Over the ensuing years, the abnormality had gradually spread to involve the whole of the cheeks, producing marked erythema. At the time of presentation, she was complaining of discomfort to the involved skin and had erythema and horny follicular plugs affecting the outer parts of the eyebrows and both cheeks. There was slight loss of hair from the lateral third of the eyebrows. There was no family history of similar skin problems and she had no scalp involvement.

Previous therapies consisted of a vast range of topical medicaments, including 4% sulphur and salicylic acid ointment, azelaic acid, several antimicrobial preparations, ketoconazole, and Retin-A gel, all of which were unsuccessful. Systemic antibiotics were also ineffective; in view of her lack of response to previous therapies, it was decided to treat her with isotretinoin at a dose of 1mg/kg/day. After a 16-week course of isotretinoin, she showed marked improvement. The horny plugs were no longer evident and the erythema had subsided. The isotretinoin was stopped at this stage.

She remained much improved for 6 months, but the problem subsequently recurred. She was therefore given a second course of isotretinoin (1mg/kg/day), and treatment continued for 5 months. This produced marked improvement again, and the benefit appears to be maintained 12 months later.

Ulerythema ophyrogenes represents a form of keratosis pilaris, which is possibly genetically determined, although many cases, as in this patient, appear to occur sporadically {1}. It typically develops in infancy, and affects the eyebrows and cheeks. Horny keratin plugs are interspersed with erythema, producing a potentially cosmetically disfiguring appearance. Associated developmental retardation has been recorded, although this is by no means universal {2}. Scalp involvement has also been described, but apparently this does not occur when eyebrows are the predominant site of involvement. Efforts of treatment are notoriously unsuccessful, although anecdotal reports have suggested that retinoids may theoretically be of value. {3}

We believe this to be the first reported case in the literature demonstrating isotretinoin as a successful treatment for this condition. The use of isotretinoin is unlikely to cure the condition but this case suggests that it may produce prolonged peroids of improvement. Provided the recommended guidelines for the use of isotretinoin are followed, repeat courses are safe, and apparently effective in the treatment of this refractory condition.

Department of Dermatology
The General Infirmary at Leeds
Great George Street
Leeds LS1 3EX. U.K

I know that if and when my son shows definate signs of continuing hair loss that I will persue treatment with Isotretinion (accutane, roaccutane)

I wrote to Professor Cunliffe (the author of the above article) about 9 years ago. The Derm who diagnosed me gave me this article and tried me on 40mg of roaccutane (isotretinion) for a year. My skin did not change but I believe this is because my skin was past the inflammatory stage. The redness I had was just damaged blood vessels. Professor Cunliffe replied to say that cases of UO and atrophoderma vermiculata are rare and this is the only one he had had opportunity to treat.

Other medical journal articles do state however that isotretinion has helped with atrophoderma vermiculata and a variant of KPRF.

The isotretinion seems to stop the inflammation which is the thing that causes the damage to the hair follicule and also results in redness and scarring in the eyebrow area.

I know that ones on this board have blamed isotretinion for making their KP worse - this was not the case with me. If your derm is not familiar with this article it may be worth showing it to him/her.

Any comments, thoughts, questions welcome.

Anne

This is me . Please note that I have had two v-beam pulse dye laser treatments on this area and this has helped change the colour from red to more of a dark pink.

Attached Images

1491.bmp (98.5 KB, 187 views)

I think I'll pass.............








Most adverse effects resemble vitamin A toxicity. Adverse drug reactions associated with isotretinoin therapy include:[2]

• Common: mild acne flare, dryness of skin, lips and mucous membranes, cheilitis, itch, skin fragility, skin peeling, rash, flushing, photosensitivity, nose bleeds, dry eyes, eye irritation, conjunctivitis, reduced tolerance to contact lenses, hyperlipidaemia, raised liver enzymes, headaches, hair thinning, myalgia and/or arthralgia.
• Infrequent: severe acne flare, raised blood glucose level, increased erythrocyte sedimentation rate, fatigue and/or mood changes.
• Rare: impaired night vision, cataracts, optic neuritis, menstrual disturbances, inflammatory bowel disease, pancreatitis, hepatitis, corneal opacities, papilloedema, idiopathic intracranial hypertension, skeletal hyperostosis, extraosseous calcification, moderate memory loss

The following adverse effects have been reported to persist, even after discontinuing therapy: alopecia (hair loss), arthralgias, decreased night vision, degenerative disc disease, keloids, bone disease, depression (in some cases). High dosages of isotretinoin have been reported to cause rosacea.

You mentioned in another post that you've never seen anyone loose more than the outer third....but in this image it looks like you've lost more? Just curious.....

One other comment....if the key to avoiding the hair loss is keeping the inflammation down, I wonder why cortisone doesn't work for people?

No - I can understand regarding the hesitancy about using any drug - they all have some sort of side effects.

After one years use of Roaccutane the only thing that effected me was the constant dry lips but I appreciate people react differently to drugs.

With regards to the eyebrow hair - that side is missing more than the other one. My eyebrows used to get really really itching and I would often scratch at them causing them to bleed (bad habit) - I think this has produced some extra hair loss on this one.

I hope you find an effective treatment. There is very little written about UO treatments but I suspect anything like an AHA may be a good place to start if they skin will tolerate it. I use retin-a cream on my eyebrow area to keep the odd KP bump at bay and my skin is okay with it (initially it flared up a bit but now it is fine).

Not sure - all I know is that Ulerythema Ophryogenes and Atrophoderma Vermiculata have been put under the heading of Keratosis pilaris atrophicans faciei. The reason for this is that the 'atrophy' (waste, damage) the skin causing damage to blood vessels and hair loss.

UO is obviously a more aggressive thing than KPRF and just treating it on the surface doesn't seem to be so effective. However in saying that there haven't been a lot of posts on this site about people trialling different creams so it may well be that some of these things do help.

Like you I don't have a lot of answers but am keen to toss out ideas to get some discussion going on what people have tried to treat this condition.