15 - Hair

Question 1

Types of hair?

Answer 1

1. Terminal hairs - thick pigmented hair
   - scalp, beard, axilla, pubic
2. Lanugo hairs - fine hairs of fetus
3. Vellus hair - short fine hairs
   - covers much of body

Question 2

Androgen and hair?

Answer 2

Terminal hairs require androgens

Vellus hair are independent of androgens

Question 3

Stages of hair growth?

Answer 3

Catagen (transitional phase)
Telogen (resting phase)
Anagen (growing phase)

Question 4

Most hair is in what stage?

Answer 4

Anagen (growing) phase - 90%

Telogen (resting phase) 10%

Question 5

Alopecial chart

Answer 5

Slide 7

Question 6

telogen effluvium

Answer 6

Diffuse loss of hair
Normal healthy scalp
Loss of resting hair 
Last 4 weeks 
Any age

Question 7

telogen effluvium, how much hair is lost?

Answer 7

Up to 50%

Question 8

Who gets telogen effluvium the most?

Answer 8

Women, its also related to stress mostly

Question 9

Etiology of telogen effluvium?

Answer 9

Loss of resting hairs
Ready to be shed 
Follows: 
- physical, emotional stress
- delivery of child
- dc oral contraceptives
- high fever, surgery
- serious wt loss

Question 10

Tx for telogen effluvium?

Answer 10

Reassurance - it’ll grow back

Full recovery expectd

Question 11

What is androgenic alopcia?

Answer 11

Male pattern baldness

- due to progressive shortening of successive androgen cycles

Question 12

Pt profile for androgenic alopecia?

Answer 12

Family hx

Thinning age is 12-40

Question 13

Morphology of androgenic alopcia?

Answer 13

Top/vertex - androgen sensitive

Sides - androgen independent

Question 14

Tx for androgenic alopecia

Answer 14

Minoxidil (rogane) topical
Finasteride (propecia) oral
Dutasteride (avodart) oral
Transplant
Advancement flaps
Hair weave 
Toupe

Question 15

How does minoxidil (rogaine) work?

Answer 15

Increases duration of anagen - follicles rest to grow and enlarges miniaturized follicles

Can take up to 1 yr to start working

Question 16

Ideal candidate for minoxidil?

Answer 16

Male
<30 yrs
<5 yrs hair loss

Question 17

How does dutasteride (avodart) work?

Answer 17

Dual inhibitor of type I and II 5a-reductases

- inhibits conversion of testosterone to DHT

Question 18

Androgenic alopecia - female pattern etiology

Answer 18

Begins in 20-30’s to perimenopausal

- drop in estrogens relitive to increase in androgens

Question 19

Morphology of female pattern baldness?

Answer 19

Loss on vertex

- not as complete as male pattern

Question 20

Labs for female pattern?

Answer 20

Check

DHEA-S
Prolactin
Testosterone
SHGB

Question 21

Tx for female pattern baldness?

Answer 21

OTC minoxidil

Question 22

What is alopecia aretata?

Answer 22

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)

Question 23

Presentation of alopecia aretata?

Answer 23

Sudden asymptomatic loss
Round, sharply defined patches
“Exclamation point” hair

Question 24

With alopecia aretata you should check for?

Answer 24

Nail pitting

- 10-66% incidence

Question 25

Etiology of alopecia areata?

Answer 25

Autoimmune disease
- thyroid disease and vitiligo are associated with it
Family/genetic

Stress??

Question 26

Alopecial aretata txt?

Answer 26

<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

Question 27

Prognosis for alopecia areata?

Answer 27

Best for adults w small area

Totalis, universalis or ophiasis has worse prognosis

Question 28

What is trichorrhexis nodosa?

Answer 28

Brittle hair due to overworking
Weak points/nodes in hair shaft
- can cause permanent loss due to scarring

Broken fried over dyed hair

Question 29

Tx for trichorrhexis nodosa?

Answer 29

Must stop all hair tx

Screen for HYPOthyroid

Question 30

Traction alopecia

Answer 30

Tight braiding of hair

• fractures hair shaft
• damages follicle
• hair line recedes

Question 31

Tx for traction alopecia?

Answer 31

Stop what youre doing

Question 32

What is hirsutism?

Answer 32

Presence of terminal hairs in females in a male-like pattern

Question 33

How bad is hirsutism?

Answer 33

Its benign

- cosmetic only

Question 34

Etiology of hirsutism?

Answer 34

High androgen levels
- from ovaries or adrenal glands

Or

Increased follicle sensitivity to normal androgen levels

Question 35

Possible causes of hirsutism?

Answer 35

PCOS 
Cushing
Androgen-secreting tumors
Corticosteroids
Obesity

Question 36

MCC of hirsutism?

Answer 36

PCOS

Question 37

Tx hirsutism

Answer 37

Cannot be cured (suppression only)
Oral contraceptives
Low dose corticosteroids
Spironolactone 
Eflornithine HCL  (vaniqua)
Laser, electrolysis
Waxing, tweezing, plucking

Question 38

Hirsuitism presentation?

Answer 38

Slide 50 has a sweet pic

Question 39

Hypertrichosis is?

Answer 39

Excessive hair growth (density, length) beyond accepted limits normal for age, race, sex
- in areas that are NOT androgen sensitive

Question 40

Hypertrichosis hair types

Answer 40

May involve lanugo, vellus, or terminal hair

Question 41

Hypertrichosis spares?

Answer 41

Palms and soles

Question 42

Etology of hypertrichosis?

Answer 42

Genetic d/o
Drugs
- minoxidil
- phenytoin
- cyclosporine
- corticosteroids

Internal malignancy

Question 43

What did the farmer call the cow with no milk?

Answer 43

An udder failure