Hair Disorders Flashcards
What are the hair disorders?
Alopecia Areta Androgenetic Alopecia Hair structure & color defects Telogen Effluvium Anagen Effluvium Pseudofolliculitis barbae & folliculitis
What is the hair growth cycle?
Anagen - period of growth – 3 to 6 years
Catagen - period of transition - 2 weeks
Telogen- period of rest - 3 to 4 months
What represents 90% of hairs?
anagen
What represents 10% of hairs?
catagen and telogen
What is alopecia areata?
discrete annular patches of hair loss without scalp disease or scaring
What is hair loss of the entire scalp?
alopecia totalis
What is hair loss on entire body?
alopecia universalis
What do you see on exam of alopecia areata?
broken off hair, exclamation point hairs at periphery of lesions
What do you see in nails of pt with alopecia areata?
nail pitting, longitudinal striation
20% pt
What associated disorders of alopecia areata?
Vitiligo
Familial multiendocrine syndrome
Thyroid disease
Stress
What is the work up for alopecia areata?
Thyroid studies
Serum Iron - Rule out Anemia
ANA - Rule out SLE
What is the treatments for alopecia areata?
Topical steroids
Intralesional injection of triamcinolone
tacrolimus (Protopic) and pimecrolimus (Elidel)
What does tacolimus and pimecrolimus do?
inhibit t lymphocyte activation
short term use only due to risk of malignancy
Is there a cure for alopecia areata?
no, supplement with wigs, make up or psychological support
What is androgenetic alopecia?
Progressive balding
Genetic predisposition
Androgen action
Who gets androgenetic alopecia?
men > females
How does androgenetic alopecia appear in men?
receding anterior hairline, bald spot on posterior crown
How does androgenetic alopecia appear in females?
Diffuse loss of hair
Thinning appearance
Endocrine work up if indicated
What is the pathology of AGA?
Circulating androgens are converted to dihydrotestosterone (DHT) by 5 alpha reductase (5R)in the hair follicle.
In AGA there is an increase of (5R) therefore an increase of DHT.
DHT causes an increase in the telogen phase and a shortening of the anagen phase
What is the first treatment for AGA?
Topical minoxidil (Rogaine) 2% for women, 5% for men Apply to scalp BID, if no regrowth in 4 months then d/c
What is another AGA treatment?
Interferes with conversion of testosterone to 5-alpha=dihydrotestosterone PO finasteride (Propecia) 1mg PO Qday for men only. Min 3 months- stop tx sxs return within 12 mos
What are the side effects of finasteride?
Teratogenicity (in male fetus)
Erectile dysfunction and infertility
Who is finasteride contraindicated in?
women and children
What is the most extensive tx for AGA?
hair transplant
What is Loss of hair in the Telogen (resting) phase?
Telogen effluvium
What is telogen effluvium associated with?
Post partum Crash dieting Surgery Birth Control Pills High Fever Drugs - Anticoagulants, Heparin, Lithium, Accutane, Allopurinol, Propanolol, many others
What is the treatment for telogen effluvium?
resurrance will grow back
What is Loss of hairs in Anagen (growth) Phase?
anagen effluvium
What causes anagen effluvium?
Chemotheraputic, Anticancer agents
- Antimetabolite
- Alkylating agents
- Mitotic inhibitors
- Doxorubicin
What is the pathology of anagen effluvium?
1-2 weeks of high doses of chemotheraputic agents
Anagen hair shaft abruptly thinned
As this portion reaches the surface all hairs break off simultaneously
What is the treatment effluvium?
reassurance - reversible with time
What is Trauma related to hair styling?
Traction alopecia
What are causes of TA?
“Corn Rows”
“Pony Tails”
“Hair Extensions, Weaving”
What is the treatment for traction alopecia?
Change hair style Early TA - reversible Early TA with anti-inflammatory -topical steroids Late TA - permanent hair loss Late TA - no treatment is available
What are the causes of hair color defects?
Premature Canities (graying)
Poliosis (patchy decrease in melanin)
Albinism
What is the age for whites with premature canitis?
What is age for AA with premature canitis?
What is the highest etiology of premature canitis?
GENETIC
What do you need to work up for premature canitis?
Pernicious anemia
B-12 deficiency
Thyroiditis - Alters activity of melanocytes
What is selective loss of pigmented hair?
rapid overnight graying
What is Localized loss of hair pigment ?
poliosis
What is poliosis etiology?
congenital/genetic or autoimmune
What is the color of hair in albinism?
white or colorless
What is albinism linked to?
genetic defect in melanin pathway, many different types
What system does albinism also affect?
optic from hypopigmentation
What do you see optically for albinism?
Photophobia
iris transillumination
Nystagmus
pigment deficiency in the peripheral retina
How do you dx albinism?
Hair bulb assays help to indicate the status of tyrosinase activity
Multiple classifications
(OCA 1, 1A, 1B, 2, 3; OA1, AROA)
DNA sequencing
What is the treatment for albinism?
Nitisinone
hereditary tyrosinemiaa type 1
Investigational, not FDA approved
What can cause folliculitis?
Bacterial
Chemical irritation
Physical injury
What is the treatment for folliculitis?
Eliminate the cause
Treat underlying infection:
Most common (Staphylococcus Aureus)
“hot tub” folliculitis (Pseudomonas aeurginosa)
Topical antibiotics
Systemic antibioticsWhat is hair grows out of follicle, then curls and repenatrates the skin?
pseudofolliculitis barbae
What causes pseuedofolliculitis barbae?
Curly hairs
African American men
Close shaving
What is the treatment for pseuedofolliculitis barbae?
discontinue close shaving - clip hairs, depilatories, laser
treat like acne
incision and removal of hair
How long does it take for hair to grow back?
cancer - years to get full, see growth over time
