Does hydrocortisone cream cause hair growth

Jimmy Dooley`s fledgling modeling career came to an abrupt halt when he began losing hair by the handfuls last November.

The fashion industry, with its high premium on stylized standards of beauty, had no place for a bald model with very few eyelashes and smooth, slick patches on his chin.

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''I was devastated, totally at the end of my rope when the doctor said I could lose every hair on my head,'' said Dooley, 32, who lives in Denton, Texas. ''Sixty days later, I looked like a mutant. If ever there was a time that I could have committed suicide, this was it.''

He still hides from some people and refuses to go to some of the old haunts, where his thick, dark wavy hair, good looks and self-confidence once turned heads and opened doors.

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However, he has regained his sense of humor, and he says alopecia areata is not the end of the world.

It could be worse: He could be sick.

Most patients with the baffling hair-loss disorder are otherwise healthy, and although the disease may be psychologically devastating, it poses no medical threat. ''My doctor says he has hundreds of patients who would trade places with me,'' Dooley said.

Christiane Buuck of Bedford, Texas, had just started 1st grade when the smooth, hairless round spots appeared on the crown of her head, and she was diagnosed with alopecia areata. After a few months of treatment with a hydrocortisone cream, the hair grew back and the quarter-size bald patches disappeared.

But when she was in 3rd grade, Christiane and her mother, Libby Buuck, noticed that the part separating her pigtails seemed to be growing wider by the week. By sixth grade about 90 percent of Christiane`s hair had fallen out, and all the hair on her arms and legs was gone.

''She was going to a swim party that summer after 3rd grade, and I was afraid someone might say something about her hair falling out that would embarrass her or hurt her feelings, so I did a little role-playing with her and asked her what she would do if someone said something about it.

''She said that she would ask, `Do you think I haven`t noticed?''` Buuck said.

Now ready to start 8th grade, the self-confident teenager, who threw away her wig after wearing it four times and began wearing baseball hats with bows in the back-not to hide the bald spots but to keep the top of her head cooler in summer and warmer in winter-has most of her hair back.

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''She was fortunate that it first happened when she was so young,'' Buuck said. ''She really wasn`t into hair yet. It would have been harder if it had all fallen out in 8th grade. She`s really been inspirational to us. She`s so strong and has such a `can-do` attitude. She just accepts the fact that it`s not the end of the world.

''You never know what triggers the loss or the regrowth. We still panic whenever three hairs fall out,'' said Buuck, who headed an area support group for people with alopecia areata for several years.

Alopecia areata is not associated with any sickness or disease and affects one-half to 1 percent of the population by the age of 50, or as many as 2.5 million people to some degree, often very minor.

When the condition spreads until all the hair on the scalp is lost, it is called alopecia totalis, and when hair is lost over the entire body, the condition is called alopecia universalis.

''Total hair loss is very, very rare. I`ve only had two patients lose all their hair in the nine years I`ve been practicing here,'' said Dr. Danny Thomas, a Ft. Worth, Texas, dermatologist, who has about 10 patients with alopecia areata at any one time.

''Usually if it is one or two isolated patches, they grow back in after a month or two. It is most common in young adults between the ages of 20 and 30 but is also seen in early childhood.''

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Family histories are involved in about 20 percent of the cases, and there have been reports of identical twins developing the condition simultaneously. Stress, seasons and various infections seem to trigger the disorder.

It is believed to result from a misdirected and overactive immune response. The body forms antibodies against some part of the hair follicle (a type of self-allergy).

''You`re trying to reject your hair,'' said Dr. David Whiting, a dermatologist with the University of Texas Southwestern Medical School and medical director of the Baylor Hair Research and Treatment Center in Dallas. More than 10 percent of the 5-year-old center`s 3,000 patients have had alopecia areata.

Unlike with some other forms of baldness, the hair follicle remains alive with alopecia areata and so does hope for a cure.

''A lot of research is going on,'' Whiting said. ''The whole hair business has sort of taken off, largely because of minoxidil (the first FDA-approved drug to stimulate hair growth). It`s stimulated a lot of

interest.''

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Minoxidil seems to be useful for regrowing hair in 30 to 40 percent of patients with immunologic hair loss, Whiting said. When patients stop using the ointment, hair likely will begin falling out again, unless the disease has gone into remission.

''Alopecia areata is an entirely unpredictable disease,'' Whiting said.

''You can lose every hair on your body, and maybe it`s all going to grow back one day and maybe it`s not. There`s nothing you can do to change the ultimate outcome.''

However several treatments are available that work for some patients, at least temporarily.

Interlesionary injections of corticosteroids, that is, tiny drops of cortisone injected directly into the bald spots, are still the best treatments for the patch-type form of the disease, Whiting said. Cortisone also can be rubbed into the scalp but does not seem to work quite as well.

Other sometimes-useful treatments include steroids, ultraviolet light, PUVA (a treatment combining light-sensitizing medication and ultraviolet light) and anthralin, a skin-irritating ointment widely used for the treatment of psoriasis.

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In severe cases, doctors sometimes deliberately produce an allergic rash or mild contact dermatitis that resembles poison oak or poison ivy to irritate the scalp. All of the skin-sensitizing techniques are used because the hair follicles are in a hibernationlike state and need awakening.

Theoretically, cyclosporine, the powerful drug used to suppress the immune systems of patients receiving organ transplants, would be ideal for alopecia areata if it were available in a topical form that allows absorption through the skin, but it is not, Whiting said.

''The problem is when you stop taking it, the hair begins falling out again, and it`s such a dangerous drug you want to stop taking it as soon as possible,'' he said.

The success of any of the treatments depends primarily on whether patients have the common variety of alopecia areata with no other autoimmune disease. These are the most treatable and account for about 75 percent of all cases.

If a patient has an allergic background of hay fever, asthma or eczema along with the strange hair loss, or an endocrine disorder such as diabetes or thyroid disease, there is a greater chance of total hair loss and less chance of successful treatment.

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