- Email: [email protected]
HAIRLOSS AND SCALING WITH PROGUANIL
225 In the analysis of the relation of risk factors to the 10 year incidence of CHD in men initially free of CHD we demonstrated in multivariate analysis a strong inverse relation between alcohol and the incidence of total CHD, fatal CHD, and non-fatal myocardial infarction while taking into account other variables including age, systolic blood pressure, serum cholesterol, glucose, and uric acid, and cigarette smoking. While these analyses did not directly address histories of hypertension, diabetes, or gout, nor of treatments for these or other conditions, they did include indices of these conditions (blood pressure, post glucose load serum glucose, and serum uric acid). Furthermore, it may be inappropriate to lump all cardiovascular diseases in analyses relating to alcohol consumption, since we have demonstrated a direct relation of alcohol consumption to mortality’ &om stroke and to incidences of haemorrhagic stroke, in contrast to the inverse association with CHD. Indeed, stroke mortality may account for the right hand side of Shaper’s U or J shaped cardiovascular mortality curves.
A. KAGAN K. YANO D. M. REED
Honolulu Heart Program, Kuakini Medical Center, Honolulu, Hawaii 96817, USA
1. Yano K, Rhoads GG, Kagan A. Coffee, alcohol and risk of coronary heart disease among Japanese men living in Hawaii. N Engl J Med 1977; 297: 405-09. 2 Yano K, Reed DM, McGee DL. Ten-year incidence of coronary heart disease incidence of croronary heart disease in the Honolulu Heart Program: relationship to biologic and lifestyle characteristics. Am JEpidemiol 1984; 119: 653-66 3. Rose GA, Blackburn H Cardiovascular survey methods. WHO Monogr 1968; no 56. 4. Blackwelder WC, Yano K, Rhoads GG, Kagan A, Gordon T, Palesch MS. Alcohol and mortality: the Honolulu Heart Study. Am JMed 1980; 68: 164-69. 5. Donahue RP, Abbott RD, Reed DM, Yano K. Alcohol and hemorrhagic stroke: the Honolulu Heart Program. JAMA 1986, 255: 2311-14.
HAIRLOSS AND SCALING WITH PROGUANIL Jllj 1V1
has been
Lt1B.
FJCIJL -2 Y-’
LtlB.
lVVll.llW.r111111., LQ1-L.J-JQ1QQ111,
2500 or so expatriates, predominantly Scandinavian citizens, to evaluate the efficacy and safety of malarial chemoprophylaxis. We report here two side-effects of proguanil that, to our knowledge, have not previously been described. Hair loss was reported by 10 women; in most it was severe, the hair falling out in tufts, and 2 women had to wear a wig (table). The hair loss, which was not reported by men, was in every instance reversed when proguanil was stopped. 2 women were rechallenged with proguanil and the hair loss recurred. The onset of hair loss varied from 1 week to 2 years after the start of proguanil and the severity appeared to be proportional to the duration of use. 4 women also took chloroquine, and in 4 cases there was a history of allergy. Scaling of the skin on the palms and/or soles was reported by 4 men and 2 women, and was reversed on cessation of proguanil
following-up
(table). PATIENTS WITH HAIR LOSS OR SCALING WHILE ON REGULAR PROPHYLAXIS WITH PROGUANIL
Proguanil is widely recommended for chemoprophylaxis against malaria.’ We estimate that about 70% of Scandinavian residents in Tanzania used proguanil alone or in combination with chloroquine. About 40% of this population are women. Why hair loss has not been reported by men is unclear. Perhaps they do not attribute hair loss to drug use. Scaling occurs in both men and women but was less common.
Nordic Clinic, Dar-es-Salaam, Tanzania
STEFAN N. HANSON KIRSTEN KUYLEN
Department of Infectious Diseases, Karolinska Institute, Roslagstull Hospital, S-114 89 Stockholm, Sweden
ANDERS B. BJÖRKMAN
1. WHO.
Development of recommendations for the protection of short-stay travellers to areas memorandum from two WHO meetings. Bull Wld Hlth
malaria endemic
Org 1988, 66: 177-96.
HEREDITARY ELLIPTOCYTOSIS IN AFRICA
SIR,-We agree with Dr Fleming (Oct 8, p 857) about hereditary elliptocytosis (HE) in Africa. We have studied HE in West Africa.’ Preliminary studies in France showed that a high proportion of HE patients were black people from West Africa and Antilles. To confirm this finding, we systematically searched for HE in Benin, Burkina-Faso, Ivory Coast, and Togo. We found 22 HE cases out of 3450 subjects studied (ie, 4-6 cases of HE per 1000 for these countries). HE is roughly ten times more frequent in West Africa than in Europe or in the USA. Since HE in the black population is related to mutations of spectrin, the main erythrocyte skeletal membrane protein, we also characterised the pathological spectrin variants in the 22 HE cases. Most of the patients, who are from different ethnic groups, showed the Sp&agr;I/65 kD variant, which we previously found the most frequent.2 A second variant, SpcxI/46,3 was found in 5 cases from limited areas in south Benin and Togo, in Adja-Evhe people, who originate from the Yoruba living in Nigeria. This
study was supported by a grant from the European Communities.
INSERM U160,
Hôpital Beaujon, 92118 Clichy, France; OCEAC, ORSTOM, Yaounde, Cameroun; Haematology Laboratory CHU, Lome, Togo,
Antenne
and National Blood Transfusion Centre, BP 8042 Cotonou, Benin
D. DHERMY P. CARNEVALE I. BLOT
I.ZOHOUN
H, Bournier O, Galand C, Boivin P. Afrique de l’Ouest: fréquence et répartition des variants de la spectrine. C R Acad Sci Paris 1988; 306: 43-46. 2. Lecomte MC, Dhermy D, Solis C, et al. A new abnormal variant of spectrin in black patients with hereditary elliptocytosis. Blood 1985; 65: 1208-17. 3. Lecomte MC, Dhermy D, Garbarz M, et al. Pathologic and non-pathologic variants of the spectrin molecule in two black families with hereditary elliptocytosis. Hum 1. Lecomte
MC, Dhermy D, L’elliptocytose héréditaire
Gautero
en
Genet 1985; 71: 351-57.
SELF-INJURY, REGURGITATION, AND ANTIEMETICS
SIR,-Self-injury in mentally handicapped people has been treated with neuroleptics and behaviour modification, with limited success. In severe cases protective equipment often has to be resorted to. A 36-year-old mentally handicapped man frequently hit himself, causing cauliflower ears and recurrent ear infections. He also regurgitated daily, often with emesis. The age of onset of self-injury and regurgitation was 14 years. Behavioural approaches were unsuccessful and he had to wear a helmet. Metoclopramide 5 mg three times daily 20 min before food reduced the emesis though the regurgitation continued, sometimes for hours, after meals. The dose may have been too low.! An unexpected outcome was complete elimination of self-injury, ending need for the helmet. Months later he was given domperidone 10 mg four times daily, which halted
A. KAGAN K. YANO D. M. REED
Honolulu Heart Program, Kuakini Medical Center, Honolulu, Hawaii 96817, USA
1. Yano K, Rhoads GG, Kagan A. Coffee, alcohol and risk of coronary heart disease among Japanese men living in Hawaii. N Engl J Med 1977; 297: 405-09. 2 Yano K, Reed DM, McGee DL. Ten-year incidence of coronary heart disease incidence of croronary heart disease in the Honolulu Heart Program: relationship to biologic and lifestyle characteristics. Am JEpidemiol 1984; 119: 653-66 3. Rose GA, Blackburn H Cardiovascular survey methods. WHO Monogr 1968; no 56. 4. Blackwelder WC, Yano K, Rhoads GG, Kagan A, Gordon T, Palesch MS. Alcohol and mortality: the Honolulu Heart Study. Am JMed 1980; 68: 164-69. 5. Donahue RP, Abbott RD, Reed DM, Yano K. Alcohol and hemorrhagic stroke: the Honolulu Heart Program. JAMA 1986, 255: 2311-14.
HAIRLOSS AND SCALING WITH PROGUANIL Jllj 1V1
has been
Lt1B.
FJCIJL -2 Y-’
LtlB.
lVVll.llW.r111111., LQ1-L.J-JQ1QQ111,
2500 or so expatriates, predominantly Scandinavian citizens, to evaluate the efficacy and safety of malarial chemoprophylaxis. We report here two side-effects of proguanil that, to our knowledge, have not previously been described. Hair loss was reported by 10 women; in most it was severe, the hair falling out in tufts, and 2 women had to wear a wig (table). The hair loss, which was not reported by men, was in every instance reversed when proguanil was stopped. 2 women were rechallenged with proguanil and the hair loss recurred. The onset of hair loss varied from 1 week to 2 years after the start of proguanil and the severity appeared to be proportional to the duration of use. 4 women also took chloroquine, and in 4 cases there was a history of allergy. Scaling of the skin on the palms and/or soles was reported by 4 men and 2 women, and was reversed on cessation of proguanil
following-up
(table). PATIENTS WITH HAIR LOSS OR SCALING WHILE ON REGULAR PROPHYLAXIS WITH PROGUANIL
Proguanil is widely recommended for chemoprophylaxis against malaria.’ We estimate that about 70% of Scandinavian residents in Tanzania used proguanil alone or in combination with chloroquine. About 40% of this population are women. Why hair loss has not been reported by men is unclear. Perhaps they do not attribute hair loss to drug use. Scaling occurs in both men and women but was less common.
Nordic Clinic, Dar-es-Salaam, Tanzania
STEFAN N. HANSON KIRSTEN KUYLEN
Department of Infectious Diseases, Karolinska Institute, Roslagstull Hospital, S-114 89 Stockholm, Sweden
ANDERS B. BJÖRKMAN
1. WHO.
Development of recommendations for the protection of short-stay travellers to areas memorandum from two WHO meetings. Bull Wld Hlth
malaria endemic
Org 1988, 66: 177-96.
HEREDITARY ELLIPTOCYTOSIS IN AFRICA
SIR,-We agree with Dr Fleming (Oct 8, p 857) about hereditary elliptocytosis (HE) in Africa. We have studied HE in West Africa.’ Preliminary studies in France showed that a high proportion of HE patients were black people from West Africa and Antilles. To confirm this finding, we systematically searched for HE in Benin, Burkina-Faso, Ivory Coast, and Togo. We found 22 HE cases out of 3450 subjects studied (ie, 4-6 cases of HE per 1000 for these countries). HE is roughly ten times more frequent in West Africa than in Europe or in the USA. Since HE in the black population is related to mutations of spectrin, the main erythrocyte skeletal membrane protein, we also characterised the pathological spectrin variants in the 22 HE cases. Most of the patients, who are from different ethnic groups, showed the Sp&agr;I/65 kD variant, which we previously found the most frequent.2 A second variant, SpcxI/46,3 was found in 5 cases from limited areas in south Benin and Togo, in Adja-Evhe people, who originate from the Yoruba living in Nigeria. This
study was supported by a grant from the European Communities.
INSERM U160,
Hôpital Beaujon, 92118 Clichy, France; OCEAC, ORSTOM, Yaounde, Cameroun; Haematology Laboratory CHU, Lome, Togo,
Antenne
and National Blood Transfusion Centre, BP 8042 Cotonou, Benin
D. DHERMY P. CARNEVALE I. BLOT
I.ZOHOUN
H, Bournier O, Galand C, Boivin P. Afrique de l’Ouest: fréquence et répartition des variants de la spectrine. C R Acad Sci Paris 1988; 306: 43-46. 2. Lecomte MC, Dhermy D, Solis C, et al. A new abnormal variant of spectrin in black patients with hereditary elliptocytosis. Blood 1985; 65: 1208-17. 3. Lecomte MC, Dhermy D, Garbarz M, et al. Pathologic and non-pathologic variants of the spectrin molecule in two black families with hereditary elliptocytosis. Hum 1. Lecomte
MC, Dhermy D, L’elliptocytose héréditaire
Gautero
en
Genet 1985; 71: 351-57.
SELF-INJURY, REGURGITATION, AND ANTIEMETICS
SIR,-Self-injury in mentally handicapped people has been treated with neuroleptics and behaviour modification, with limited success. In severe cases protective equipment often has to be resorted to. A 36-year-old mentally handicapped man frequently hit himself, causing cauliflower ears and recurrent ear infections. He also regurgitated daily, often with emesis. The age of onset of self-injury and regurgitation was 14 years. Behavioural approaches were unsuccessful and he had to wear a helmet. Metoclopramide 5 mg three times daily 20 min before food reduced the emesis though the regurgitation continued, sometimes for hours, after meals. The dose may have been too low.! An unexpected outcome was complete elimination of self-injury, ending need for the helmet. Months later he was given domperidone 10 mg four times daily, which halted