Scalp And Hair Conditions Flashcards
Dandruff is considered to be a mild form of _______________
seborrhoeic dermatitis
Shampoos containing _____________ agents such as pyrithione zinc (which are widely available) and selenium may have beneficial effects in the treatment of dandruff
antimicrobial
Shampoos containing antimicrobial agents such as ______________ (which are widely available) and ______________ may have beneficial effects
pyrithione zinc
selenium
Shampoos containing _____________ extracts may be useful and they are also used in psoriasis
tar
_____________ shampoo should be considered for more persistent or severe dandruff or for seborrhoeic dermatitis of the scalp
Ketoconazole
*Corticosteroid gels and lotions can also be used
Cradle cap in infants may be treated with _____________ or _____________ applications followed by shampooing
coconut oil
olive oil
What is cradle cap?
Seborrheic dermatitis; crusty or oily scaly patches on a baby’s sclap; probably caused by maternal hormones that cause oil glands on the skin to become overactive
Which drugs may cause hirsutism? (6)
- Minoxidil (used to promote hair growth)
- Corticosteroids
- Anabolic steroids
- Androgens
- Danazol
- Progestogens
What is the mechanism of action of minoxidil?
Shortens the telogen (resting) phase of the hair growth cycle, moving hair into the anagen (active growth) phase
What are the phases of the hair growth cycle? (3)
- Anagen phase: hair grows to its full length; 85-90% of hairs are in this phase at any one time; lasts 2-6 years, during which time the hair grows continuously
- Catagen phase: transitional stage; lasts about 2-3 weeks; growth stops and outer root sheath shrinks and attaches to the root of the hair
- Telogen phase: entire hair structure rests for several months; phase lasts for ~100 days; about 25-100 telogen hairs are shed normally each day
(Then re-enters anagen phases)
*minoxidil improves blood flow to scalp, shortening telogen phase to promote hair growth and improve thickness, density, and overall health of hair
_________________ can reduce hirsutism in obese women
Weight loss
Women should be advised about local methods of ______________, and in the mildest cases of hirsutism this may be all that is required.
hair removal
Eflornithine a(n) ______________ drug, inhibits the enzyme ornithine decarboxylase in hair follicles. Topical eflornithine can be used as an adjunct to laser therapy for facial hirsutism in women.
antiprotozoal
Topical ______________, an antiprotazoal drug, can be used as an adjunct to laser therapy for facial hirsutism in women.
eflornithine
_______________ (cyproterone acetate with ethinylestradiol) may be effective for moderately severe hirsutism
Co-cyprindiol
Co-cyprindiol (_____________ with ______________) may be effective for moderately severe hirsutism
cyproterone acetate (an anti-androgen)
ethinylestradiol
______________ is an alternative to co-cyprindiol in women with hirsutism secondary to polycystic ovary syndrome [unlicensed indication]
Metformin hydrochloride
- Systemic treatment is required for 6–12 months before benefit is seen
The MHRA/CHM have released important safety information regarding the use of cyproterone acetate and the risk of _______________.
meningioma
Cyproterone acetate is a component of co-cyprindiol
______________ is licensed for the treatment of androgenetic alopecia in men
Finasteride
- Continuous use for 3–6 months is required before benefit is seen, and effects are reversed 6–12 months after treatment is discontinued
Finasteride is licensed for the treatment of _____________ alopecia in men
androgenetic
- Continuous use for 3–6 months is required before benefit is seen, and effects are reversed 6–12 months after treatment is discontinued
Topical application of minoxidil may stimulate limited hair growth in a small proportion of adults but only for as long as ______________
it is used
What are the common side effects of eflornithine? (4)
- Alopecia
- Increased risk of infection
- Paresthesias
- Skin reactions
(Rarely face edema, flushing, oral disorders, skin hemorrhage, and skin neoplasms)
Is eflornithine safe to use in pregnancy and breastfeeding?
No, avoid
Use of cyproterone acetate, including co-cyprindiol, for all indications is contra-indicated in those with _____________ or a history of ______________
meningioma
meningioma
What are the contra-indications to using co-cyprindiol? (13)
- Acute porphyrias
- Current breast cancer
- Heart disease associated with pulmonary HTN and risk of embolus
- History of stroke or TIA
- IHD
- Known thrombogenic mutations
- Medical treatment of varicose veins
- Migraine with aura
- Positive antiphospholipid antibodies
- Presence or history of liver tumors
- Previous or current venous or arterial thrombosis
- Severe or multiple risk factors for arterial or venous thrombosis may
- SLE with antiphospholipid syndrome
(Same contraindications as for estrogen)
There is an increased risk of ________________ in women taking co-cyprindiol, particularly during the first year of use.
venous thromboembolism
- The incidence of venous thromboembolism is 1.5–2 times higher in women using co-cyprindiol than in women using combined oral contraceptives containing levonorgestrel, but the risk may be similar to that associated with use of combined oral contraceptives containing third generation progestogens (desogestrel and gestodene) or drospirenone. Women requiring co-cyprindiol may have an inherently increased risk of cardiovascular disease.
What are the common side effects of co-cyprindiol? (7)
- Abdominal pain
- Breast abnormalities
- Depression
- Headache
- Mood altered
- Nausea
- Weight changes
Is co-cyprindiol an effective contraceptive?
Yes; however it should not be used solely for contraception but reserved for women who require treatment for androgen-dependent skin conditions. Patients should not take other hormonal contraceptives while being treated with co-cyprindiol.
Is co-cyprindiol safe to use during pregnancy and breastfeeding?
Avoid during pregnancy due to risk of feminization of male fetus with cyproterone (anti-androgen)
Avoid if breastfeeding due to anti-androgen effects
Is co-cyprindiol safe to use in hepatic and/or renal impairment?
Caution in hepatic impairment; avoid in severe or active disease
What is the mechanism of action of finasteride?
A specific inhibitor of the enzyme 5α-reductase, which metabolises testosterone into the more potent androgen, dihydrotestosterone
What are the indications of finasteride? (2)
- BPH
2. Androgenetic alopecia in men
The MHRA has received reports of _____________ and, in rare cases, _____________ in men taking finasteride (Propecia®) for male pattern hair loss; _____________ is also associated with Proscar® for benign prostatic hyperplasia.
depression
suicidal thoughts
depression
- Patients should be advised to stop finasteride immediately and inform a healthcare professional if they develop depression
Finasteride should be used with caution in which patients?
Those with obstructive uropathy
What is the common side effect of finasteride?
Sexual dysfunction
Rarely breast abnormalities, depression, infertility, testicular pain, palpitations, and angioedema
Finasteride is excreted in semen and use of a condom is recommended if sexual partner is _______________.
pregnant or likely to become pregnant
How does finasteride effect laboratory tests?
Decreases serum concentration of prostate cancer markers such as prostate-specific antigen; reference values may need adjustment.
what patient and carer information should be given regarding finasteride? (2)
- Women of childbearing potential should avoid handling crushed or broken tablets
- Cases of male breast cancer have been reported; promptly report any changes in breast tissue such as lumps, pain, or nipple discharge
Finasteride _____ (is/is not) prescribable in NHS primary care for the treatment of androgenetic alopecia in men.
Is NOT (in primary care)
