69-70 Flashcards
Christmas tree pattern
Widened part line seen in female pattern hair loss
occipital hair loss
ophiasis
Genetic loci implicated in male pattern hair loss
Androgen receptor, estrogen receptor-beta, and aromatase
Enzyme implicated in androgenic alopecia
5 alpha reductase, type 2
Possible new therapeutic target for treatment of AGA
Prostaglandin H2
Scales used to classify pattern of mail AGA versus female
For male: Hamilton and Norwood
For female: Ludwig; for part line: Sinclair scale
AGA trichoscopy
Brown halos
AA trichoscopy
Yellow dots, exclamation point hairs, and dystrophic hairs
Trichotillomania trichoscopy
Hair shafts of different lengths, broken hairs, and black dots
Tinea capitis trichoscopy
Comma and zigzag hairs
DLE trichoscopy
Red dots
LPP trichoscopy
White dots (due the loss of melanin over scarred fibrotic tracts and perifollicular fibrosis)
Monolethrix trichoscopy
Broken hair shafts plus hairs with beads
Trichorrhexis invaginata
Bamboo hairs, broken hair shafts and nodose swellings
Pathophys of CCCA
–Premature dislocation of the inner cheek
–Eccentric epithelial atrophy
–Concentric lamellar fibroplasia (onion skin like fibrosis)
-Variable intensity specific particular location, primarily at the level of the upper isthmus and lower
Pathophys of LPP
–Bandlike mononuclear cell infiltrate obscuring the interface follicular epithelium and dermis; vacuolar alteration at the interface hypergranulosis with infundibula typical
–Colloid and Civatte bodies are occasionally found as part of the interface alteration
–Inflammation affects the upper portion of the follicle (infundibulum and isthmus) most severely
–Additionally, epidermal changes of LP are found
Pathophys of discoid lesions of lupus erythematosus
–Vacuolar interface alteration of the follicular epithelium; epidermis may be spared
–The interface change in follicles is usually vacuolar rather than lichenoid (less inflammation)
–Chronic inflammation (often including plasma cells) of the eccrine sweat glands and arrector pili is sometimes present
–Increased dermal mucin is often present
–Granular deposits of IgG and C3 at the dermal epidermal junction and/or the junction of the follicular epithelium and dermis are typical
Drugs associated with telogen effluvium
Retinoids, anti-convulsant, anti-thyroid medication, anticoagulants (especially heparin), lithium, and interferons
What reflects the total body iron storage?
Ferritin
Which cell type drives the autoimmune process seen and alopecia areata?
CD8+ T cells
Cytokines involved in alopecia areata
T cells produce IFN gamma and gamma chain cytokines (IL 2, 7, 15, 21) which indicates signaling via the JAK/STAT pathway
Immune privilege seen in hair follicles during which phase?
Anagen phase
Hair color and alopecia areata
During active disease, non-pigmented hairs are initially spared; with regrowth, the hairspray initially be gray or white, but re-pigmentation is usually observed within a few weeks or months
Most common nail findings and alopecia areata
Nail pitting, trachyonychia (sandpaper like roughness due to excessive longitudinal raging), brittle nails, onycholysis, koilonychia and, rarely, onychomadesis
Systemic steroids and alopecia areata
Approximately 80% of patients will respond to high-dose systemic corticosteroids; however about 50% will relapse with dose reduction or cessation of therapy
Topical immunotherapy for alopecia areata
diphencyprone or aquatic acid dibutyl ester; applied once weekly to affected areas; titrated according to the severity of the reaction of the previous week – tolerable degree of erythema, scaling, and pruritus
First line pharmacologic therapy for trichotillomania
Clomipramine
A patch of alopecia present at birth or acquired during the first decade of life, in the temporal area, which persists for life
Temporal triangular alopecia
Disease of black women with thick scalp and alopecia
Lipedematous alopecia
psoriasiform alopecia
Seen in association with the TNF alpha inhibitor (infliximab and adalimumab)
Baby that fails to regrow nearly all their hair after shedding their initial growth of hair shortly after birth
Congenital atrichia with papules
What does scarring alopecia mean?
It means that the follicular epithelium has been replaced by connective tissue leading to permanent hair loss
Difference between primary scarring alopecia versus secondary
In primary, the target of information appears to be the follicle, whereas with secondary, the follicle is an “innocent bystander” in the disease process for example 2/2 deep burns, radiation dermatitis, cutaneous malignancies, cutaneous sarcoidosis, morphea, necrobiosis lipoidica, and certain chronic infections such as cutaneous TB
List of lymphocytic scarring alopecia’s
Discoid lesions of lupus erythematosus, LPP (including frontal fibrosing alopecia), classic pseudopelade (Brocq’s alopecia), CCCA
List of neutrophilic scarring alopecia’s
Folliculitis decalvans, dissecting cellulitis
List of mixed scarring alopecia’s
Acne keloidalis, acne necrotica, erosive pustular dermatosis
For treatment of non-inflammatory CCCA
Combination of long acting oral tetracycline plus a potent topical corticosteroid
For highly inflamed CCCA
May do an initial 10 week regimen of oral rifampin and clindamycin
Another name for end stage scarring alopecia
Brocq’s alopecia
Most common location of discoid lupus erythematosus lesions
Face, ears, and scalp
What is the follicular occlusion triad
Dissecting cellulitis, hidradenitis suppurativa, and acne conglobata
Pathophysiology of dissecting cellulitis
Follicular hyperkeratosis rather than infection start to play a primary role in pathogenesis, however bacterial superinfection can occur
Clinical description of dissecting cellulitis
Lesions begin as multiple, firms scalp nodules, most commonly on the med and posterior vertex an upper occiput. The nodules rapidly develop into interconnecting, foggy, fluctuant, overall and linear ridges that eventually discharge purulent material
Treatment of dissecting cellulitis
Isotretinoin (0.5 to 1.5 mg per kilogram daily until four months after achieving a clinical remission)
Define folliculitis decalvans
A highly inflammatory form of scarring alopecia or inflammatory, follicular papules and pustules dominate the clinical picture; often but not always staphylococcus aureus can be grown from pustular or crusted lesions
Monilethrix
Beaded hair, inherited in an autosomal dominant fashion, affected keratin and desmoglien genes (in the AR form), usually only involves the scalp Dash hair shops have uniform elliptical nodes of normal thickness and intermittent abnormal constrictions
What test must children with pili torti have?
Early testing for hearing loss
X linked recessive disorder of copper metabolism (ATP7A gene), with the affected males having pili torti, severe psychomotor retardation, growth failure, seizures, and other neurologic abnormalities
Menkes disease
Syndrome associated with trichorrhexis invaginata
Netherton syndrome (SPIK5 mutation)
Most common structural hair abnormality characterized by shaft fracture in which the individual cortical cells and their fragments splayed out
Trichorrhexis nodosa
