Alopecia and hair loss Flashcards
List 3 types of non-scarring hair loss
- Telogen effluvium
- Alopecia areata
- Androgenic alopecia
What are the 3 phases of hair growth, the duration of hairs in that phase and the length that phase
Telogen (“resting”, 4-15%, 2-3 months)
Anagen (“growth”, 85-90%, 3-7 years)
Catagen (“regression”, <1%, 2-6 weeks)
What hair cycle phase is prolonged in pregnancy?
How does postpartum telogen effluvium occur?
How long does it last?
Anagen
Withdrawal of estrogen results in release of anagen follicles into catagen
6 weeks to 3 months later
What is a positive hair pull test
10 hairs grasped firmly between thumb and index finger.
Traction applied as hairs are pulled along their length.
What are characteristics of female pattern hair loss (FPHL)?
- Increased scalp visibility
- Absence of temporal thinning
- Broadening of central parting
List 3 indications for laboratory investigations with female pattern hair loss (FPHL)
What tests would you perform?
- Rapid onset or PCOS
- DHEAS, FSH/LH, free androgen index, prolactin, testosterone
- Telogen effluvium
- ferritin, iron studies
- thyroid function testing
- Pre-treatment
- liver function
- renal function
- Metabolic syndrome
- lipid profile
- fasting glucose, insulin and HbA1C
Which medical diagnosis has a statistically significant association with female pattern hair loss (FPHL)?
Metabolic syndrome (especially if increased waist circumference and hypertension)
What are the recommended treatment options for female pattern hair loss (FPHL)?
What is considered for intolerant/unresponsive FPHL?
Traditional
- Topical minoxidin 2%/5% to stimulate regrowth
- Oral antiandrogens (spironolactone, cyproterone acetate) to arrest progression
- Oral minoxidil (consider when tolerance/adherence is an issue)
Intolerant/Unresponsive
- Finasteride (breast CA association), dutasteride, fluridil or flutamide (liver fn)
How does stem cell treatment work for hair growth?
- Driven by adipocyte lineage cells (paracrine mechanism)
- Dermal papilla cells regulate hair follicle growth
What is an indication for systemic therapy in alopecia areata?
Skin surface area ≥20%
What is the likelihood of recovery with alopecia areata?
In terms of timing, what is considered acute vs chronic?
- 40% complete remission within 6 months
- 27% additional patches with complete remission in 1 year
- 33% chronic AA
- 55% have persistent/multifocal relapsing/remitting disease, 30% alopecia totalis
- 15% alopecia universalis)
< 1 year = acute; > 1 year = chronic
List 3 systemic treatments for chronic alopecia areata
- Glucocorticosteroids
- 80% regrow on high dose prednisolone (0.5-0.75mg/kg)
- 50% relapse with reduction/cessation
- MTX
- Cyclosporin
- Azathioprine
- Dapsome
- Mycophenolate mofetil (MMF)
- JAK/STAT pathway (under investigation)
- thromboembolic concerns
- 93% world experts would recomment JAKi
List 3 types of scarring alopecia
- FFA (frontal fibrosing alopecia)
- Lichen planopilaris
- CCCA (Central centrifugal cicatricial alopecia)
- Folliculitis decalvans
- Acne keloidalis nuchae
- Dissecting cellulitis of the scalp
- Chronic cutaneous lupus erythematosus
List 3 characteristics of frontal fibrosing alopecia (FFA)
- frontotemporal hairline recession
- perifollicular erythema, hyperkeratosis
- itch, burning, pain
List 3 suspected causes of frontal fibrosing alopecia (FFA)
- Immune dysfunction (hypothyroidism)
- Hormonal exposure (post-menopausal, anti-androgen response)
- Genetic
- Anti-aging (sunscreens, facial moisturizers)
*
Describe 3 features on this image.
What is the diagnosis?
- Reduced follicular ostia
- Perifollicular
- Scale
- Erythema (not present initially, < 50%; look for sheen)
- Blue-grey dots
Frontal fibrosing alopecia
What is the diagnosis?
What are treatment recommendations?
- Lichen planopilaris
- Androgenetic alopecia
- Doxycycline
- Dermovate
- Finasteride
- Minoxidil
Name this condition
Folliculitis decalvans
