Follicular Diseases Flashcards
What follicular disease is this characteristic of?
Definition
Etiology
Pathophysiology
- Hirsutism=development of androgen-dependent terminal body hair on the lip/chin/chest/abdomen/back in a woman
- Etiology
- with virilization: PCOS, congenital adrenal hyperplasia, ovarian/adrenal tumors, exogenous adrogens, obesity, cushing syndrome, & hyperinsulinemia
- without virilization: idiopathic, drugs, hypothyroidism, excess growth hormone, hyperprolactinemia
- Patho=high androgen levels or hair follicles that are more sensitive to normal adrogen levels
What are the two main causes of hirsutism?
- PCOS=viralization, high serum androgens, menstrual irreg.
- Idiopathic/familial=normal ovulatory function & circulating androgens, no menstrual irregularitis
Clinical features and how diagnosis is determined of hirsutism?
- Clinical
- BMI > 30
- Skin = acne, seborrhea, temporal balding, acanthosis nigricans, striae, thin skin, bruising (Cushing’s, insulin resist)
- Viralization = deeper voice, frontal balding, increased muscle mass, acne, decreased breast size
- Galactorrhea=breast discharge
- Lesions/masses in abdominopelvic area
- Diagnosis
- Clinical appearance (history early menses, family hist, weight history)
- rule out drug use & familial
- If niether look for adrogen excess (high testost. check ovaries, high DHEAScheck adrenals)
- If elevated to tumor workup
- Clinical appearance (history early menses, family hist, weight history)
What is this an example of?
Telogen Effluvium
What is this an example of?
Telogen Effluvium
Definition of Telogen Effluvium
Occurrance
Reversible, nonscarring alopecia, characterized by diffuse loss of mature, terminal hairs.
Occurs when a physiologic stress or hormonal change causes a large number of hairs to enter telogen at one time.
Very common; No racial, age, or gender predilection.
History of Telogen Effluvium
increased rate of hair shedding,
often acute onset; the interval between the inciting event and the onset of shedding corresponds to the length of the telogen phase
recent stress: pregnancy, severe wt loss, major illnesses or infection, surgery, discontinuing/changing oral contraceptive, new medicine, and traumatic psychological events
What is the general appearance of Telogen Effluvium?
What is a simple test for it?
can affect hair on all parts of the body, but generally, only loss of scalp hair is symptomatic
visible diffuse hair shedding throughout the scalp
no areas of total alopecia, no scarring, and no sign of an inflammatory scalp dermatitis
gentle hair pull test: >5 telogen hairs abnormal
How is Telogen Effluvium diagnosed and what tests could be run?
usually based on Hx and PE
CBC count and iron levels
TSH
hair collections
What is the treatment for Telogen Effluvium?
no intervention is needed; complete regrowth should occur.
any reversible cause of hair shedding– such as poor diet, iron deficiency, hypothyroidism, or medication use– should be corrected
What is this an example of?
Traumatic Alopecia
What is this an example of?
Traumatic Alopecia
What is Traumatic Alopecia?
Alopecia cause by mechanical traction or chemical trauma
Where is traumatic alopecia often found?
In African American females
What are the two ways traumatic alopecia occurs?
Mechanical traction: excessive traction for prolonged periods leads to conversion of the anagen to the telogen phase.
Chemical trauma: chemical overprocessing reduces hair strength.
What are the common symptoms of traumatic alopecia?
May complain of itching or dandruff
What can be seen in an examintation of traumatic alopeica?
patchy areas of hair loss
patterns of hair loss: temporal area with tight ponytails/curlers; occipital area with tight buns; the area adjacent to the region that is braided with cornrowing.
How to diagnose traumatic alopeica?
Based on Hx and PE
Treatment of traumatic alopecia
early recognition and discontinuation of traction/chemical trauma
Prognosis of Traumatic Alopecia
Definition
Pseudofolliculitis
A foreign body inflammatory reaction; often referred to as razor bumps or ingrown hairs
Very common in African American men; also in military officers and hirsute women who shave frequently
Pathogenesis
Pseudofolliculitis
- the sharp, pointed end of a coiled hair briefly surfaces from the skin and reenters a short distance away
- sharp hair tips can penetrate skin to a depth of 2-3mm, and can pierce the follicular wall
- short coiled hairs are more likely to re-enter the skin than longer ones
History
Pseudofolliculitis
- painful acneiform eruption that occurs after shaving.
- shaving methods may include pulling the skin taut while shaving, shaving against the grain, and using double- or triple-bladed razors.
Exam and Dx
Pseudofolliculitis
Exam:
- firm papules; skin-colored, erythematous or hyperpigmented; with a hair shaft in its center.
- pustules and abscess formation can occur from secondary infection.
Diagnosis: based on Hx and PE
Prevention
Pseudofolliculitis
- avoid close shaving; use single-blade or electric razor; do not hold skin taut; trim with scissors or electrical clipper
- avoid frequent shaving
- showering or washing area before shaving
Treatment and Complications
Pseudofolliculitis
Treatment:
- chemical depilatories
- topical antibiotic lotion for mild pustular involvement; oral antibiotics for severe secondary inflammation/abscess formation
- Vaniqa
- tretinoin cream
- electrolysis, laser hair removal
Complications:
papules may lead to scarring, postinflammatory hyperpigmentation, secondary infection, and keloid formation.
What is hypertrichosis?
excessive hair growth beyond normal limits for age, sex, race in non-androgen sensitive areas
Where is hypertrychosis common?
- Can involve entire body
- spares palms and soles
What can cause hypertrichosis?
- Rare; can be congenital or acquired
- usually drug induced
- can be caused by hypothyroidism, anorexia, malabsorption…
Treatment for hypertrichosis?
Treat the underlying problem!
The common cause of these lesions (2 different lesions shown)
Furuncle (L) and Carbuncle (R)
S. aureus
Definition of Furuncle
a deep inflammatory nodule involving the hair follicle, usually following an episode of folliculitis
Definition of Carbuncle
a series of abscesses in the SQ tissue that drain via hair follicles
Clinical features of
Furuncle/Carbuncle
nodular lesions, very painful, usually drains pus spontaneously
systemic symptoms uncommon with furunculosis
fever in deeper infections (carbuncles)
Treatment of
Furuncle/Carbuncle
warm compresses to promote spontaneous drainage
antibiotic treatment directed against S. aureus
surgical drainage for severe infections
What can cause folliculitis?
a. exposure to hot tubs/pools that are contaminated with P. aeruginosa
b. longterm antibiotic or corticosteroid use can predispose for Candida folliculitis
c. immunosuppression/diabetes
What things can cause folliculitis?
History of occlusive dressings, sweating and friction
frequent shaving
How do you prevent folliculitis?
avoid shaving irritated skin, and avoid close shaving
change disposable razors periodically
good personal hygiene
What is the treatment for folliculitis?
Antibacterial soaps
topical antibiotics or antifungals
systemic antibiotics for severe or widespread infections
what should you check for/treat if someone has recurrent/chronic folliculitis?
nasal colonization of staph aureus
treat with mupirocin (bactroban) ointment in nasal vestibule x 5 days
