15 - Hair Flashcards
Types of hair?
- Terminal hairs - thick pigmented hair
- scalp, beard, axilla, pubic - Lanugo hairs - fine hairs of fetus
- Vellus hair - short fine hairs
- covers much of body
Androgen and hair?
Terminal hairs require androgens
Vellus hair are independent of androgens
Stages of hair growth?
Catagen (transitional phase)
Telogen (resting phase)
Anagen (growing phase)
Most hair is in what stage?
Anagen (growing) phase - 90%
Telogen (resting phase) 10%
Alopecial chart
Slide 7
telogen effluvium
Diffuse loss of hair Normal healthy scalp Loss of resting hair Last 4 weeks Any age
telogen effluvium, how much hair is lost?
Up to 50%
Who gets telogen effluvium the most?
Women, its also related to stress mostly
Etiology of telogen effluvium?
Loss of resting hairs Ready to be shed Follows: - physical, emotional stress - delivery of child - dc oral contraceptives - high fever, surgery - serious wt loss
Tx for telogen effluvium?
Reassurance - it’ll grow back
Full recovery expectd
What is androgenic alopcia?
Male pattern baldness
- due to progressive shortening of successive androgen cycles
Pt profile for androgenic alopecia?
Family hx
Thinning age is 12-40
Morphology of androgenic alopcia?
Top/vertex - androgen sensitive
Sides - androgen independent
Tx for androgenic alopecia
Minoxidil (rogane) topical Finasteride (propecia) oral Dutasteride (avodart) oral Transplant Advancement flaps Hair weave Toupe
How does minoxidil (rogaine) work?
Increases duration of anagen - follicles rest to grow and enlarges miniaturized follicles
Can take up to 1 yr to start working
Ideal candidate for minoxidil?
Male
<30 yrs
<5 yrs hair loss
How does dutasteride (avodart) work?
Dual inhibitor of type I and II 5a-reductases
- inhibits conversion of testosterone to DHT
Androgenic alopecia - female pattern etiology
Begins in 20-30’s to perimenopausal
- drop in estrogens relitive to increase in androgens
Morphology of female pattern baldness?
Loss on vertex
- not as complete as male pattern
Labs for female pattern?
Check
DHEA-S
Prolactin
Testosterone
SHGB
Tx for female pattern baldness?
OTC minoxidil
What is alopecia aretata?
Partial loss of scalp hair
- alopecia totalis - 100% loss on head
- alopecia universalis - 100% loss of all hair
- Alopecia areata, ophiasis pattern (band like loss)
Presentation of alopecia aretata?
Sudden asymptomatic loss
Round, sharply defined patches
“Exclamation point” hair
With alopecia aretata you should check for?
Nail pitting
- 10-66% incidence
Etiology of alopecia areata?
Autoimmune disease
- thyroid disease and vitiligo are associated with it
Family/genetic
Stress??
Alopecial aretata txt?
<10 y/o
- minoxidil
- anthralin
10+ <50% of scalp - intralesional steroid - minoxidil - anthralin >50% of scalp - minoxidil +/- topical steroid - topical immunotherapy - anthralin - systemic corticosteroids - prosthesis
Prognosis for alopecia areata?
Best for adults w small area
Totalis, universalis or ophiasis has worse prognosis
What is trichorrhexis nodosa?
Brittle hair due to overworking
Weak points/nodes in hair shaft
- can cause permanent loss due to scarring
Broken fried over dyed hair
Tx for trichorrhexis nodosa?
Must stop all hair tx
Screen for HYPOthyroid
Traction alopecia
Tight braiding of hair
- fractures hair shaft
- damages follicle
- hair line recedes
Tx for traction alopecia?
Stop what youre doing
What is hirsutism?
Presence of terminal hairs in females in a male-like pattern
How bad is hirsutism?
Its benign
- cosmetic only
Etiology of hirsutism?
High androgen levels
- from ovaries or adrenal glands
Or
Increased follicle sensitivity to normal androgen levels
Possible causes of hirsutism?
PCOS Cushing Androgen-secreting tumors Corticosteroids Obesity
MCC of hirsutism?
PCOS
Tx hirsutism
Cannot be cured (suppression only) Oral contraceptives Low dose corticosteroids Spironolactone Eflornithine HCL (vaniqua) Laser, electrolysis Waxing, tweezing, plucking
Hirsuitism presentation?
Slide 50 has a sweet pic
Hypertrichosis is?
Excessive hair growth (density, length) beyond accepted limits normal for age, race, sex
- in areas that are NOT androgen sensitive
Hypertrichosis hair types
May involve lanugo, vellus, or terminal hair
Hypertrichosis spares?
Palms and soles
Etology of hypertrichosis?
Genetic d/o Drugs - minoxidil - phenytoin - cyclosporine - corticosteroids
Internal malignancy
What did the farmer call the cow with no milk?
An udder failure
