Different types of alopecia

Question 1

Alopecia areata (patchy hair loss)

Answer 1

is a disorder of the hair follicle causing a sudden onset of localised or diffuse hair loss.

Features:

• complete hair loss (small patch or diffuse)
• a clean normal scalp
• no inflammation
• Exclamation mark hairs

Outcome:

• Small patches may recover spont. (~80%)
• while extensive (> 50% loss) has a variable course.

Treatment:

Topical potent topical corticosteroids e.g.

• betamethasone diproprionate 0.05% cream or lotion) bd—12 wks

Intradermal injections of triamcinolone (Kenacort A10)

or

Minoxidil 5% 1 mL, bd applied to dry scalp (for 4 or more mths) only when hair growing

Question 2

Androgenetic alopecia (male pattern baldness)

Answer 2

Treatment for men

• Counsel re. accepting problem
• Alternatives—wear toupee, wig or hair transplant

Medications

• Minoxidil 5%, 1 mL, applied bd to dry scalp (at least 6–12 mths) but expensive and hair loss resumes on cessation
• Finasteride 1 mg (o) daily for min. 2 yrs. Same problem as above

Treatment for women

• Counselling
• Alternatives—hair styling, wigs, camouflage

Medications

• Minoxidil (as for men)
• Spironolactone or cyproterone acetate (specialist supervision)

Question 3

Alopecia totalis

Answer 3

involves the total scalp

has at best a 50% chance of recovery in a fit adult.

Question 4

Alopecia universalis

Answer 4

the eyebrows and eyelashes are also affected

Question 5

Scarring alopecia

Answer 5

In this irreversible condition hair follicles are damaged.

A scalp biopsy is essential to determine the diagnosis.

Obvious causes:

• trauma
• severe burns
• a carbuncle
• scalp ringworm with kerion

Other causes:

• lichen planopilaris—a variant of lichen planus
• discoid lupus erythematosus
• folliculitis decalvans—probably due to S. aureus
• pseudopelade—a slowly progressive scarring condition

Question 6

Telogen effluvium

Answer 6

This is increased shedding of telogen hairs,

which can be triggered by a variety of stresses, including:

• severe stress
• childbirth
• febrile illness
• trauma
• crash dieting
• cessation of the OCP

Typical features:

• stressful event → 2–3 mth gap to diffuse hair loss
• with white bulbs on end of the hair.

If uncomplicated, recovery can be expected in 6 months.

If there is a concern about non-recovery, an option is the use of topical minoxidil for min. 4 months.

Refer if incomplete recovery or relapsing episodes.

Question 7

Anagen effluvium

Answer 7

This is hair loss during the anagen phase

• typically seen in association with cancer chemotherapy.

Anagen hair shafts are identified by their long and pigmented hair bulb (compared with the white bulb of telogen).

The follicle may remain in anagen, leading to a quick recovery or move into telogen,

• thus delaying growth by about 3 months.

Question 8

Trichotillomania (hair pulling)

Answer 8

This is patchy hair loss caused by deliberate plucking or twisting of hair shafts.

It is common (by habit) in young children

• but in older children and adults it may be an obsessive-compulsive disorder often associated with stress.

Clinical features

• Incomplete patchy alopecia
• Hairs of different length
• Hairs broken and twisted
• Strange pattern of loss
• Tends to occur on side of dominant hand