Alopecia - Block 1

Question 1

What are the 3 layers of hair?

Answer 1

1. Cuticle
2. Cortex
3. Medulla

Question 2

What are the phases of hair growth?

Answer 2

1. Anagen (growth phase)
2. Catagen (transition phase)
3. Telogen (resting phase and apoptosis)
4. Exogen (hair falls out)

Question 3

What is the length of anagen phase?

Answer 3

Short hair: 1 month
Long hair: 6 yrs

Question 4

How long is the catagen phase?

Answer 4

2-3 weeks

Question 5

How long is the telogen phase?

Answer 5

1-3 months

Question 6

What is the hormone that contributes to hair loss?

Answer 6

dihydrotestosterone

Question 7

What is the function of 5a reductase?

Answer 7

Testosterone is converted to DHT by 5a reductase

Question 8

What is an drug class that may help with male and female pattern hair loss?

Answer 8

5a reductase inhibitors

Question 9

How is alopecia linked to genetics?

Answer 9

Linked to variants of androgen receptor locus on X chromosomes

Question 10

Prevalence of genetic alopecia?

Answer 10

Higher incidence among affected males and maternal grandfathers

Question 11

What is anagen hair loss?

Answer 11

Anagen effluvium: sudden onset where hair appears thin but not fragile
* reversible with hair regrowth within 6 months

Question 12

What are some causes of anagen hair loss?

Answer 12

Autoimmune dx: Diffuse, rapid hair shedding with “exclamation mark” hairs
Chemo: Recovery usually occurs within 6 months of therapy completion
Inherited/congenital

Question 13

What is telogen hair loss?

Answer 13

Telogen effluvioum: non inflammatory with sudden onset
* Observed 3 months after med condition that stops hair growth
* Hair regrowth can occur after 4 months after withdrawal of medication-induced causes.

Question 14

What are causes of telogen hair loss?

Answer 14

1. Pregnancy
2. Stress
3. Infection
4. Weight loss
5. Autoimmune dx
6. THD
7. Vitamin def
8. Meds

Question 15

What are medications that can induce alopecia?

Answer 15

Anti-arrhythmic Agents
ACE Inhibitors (ACE-Is)
Angiotensin-II Receptor Blockers (ARBs)
Anticonvulsants
Anticoagulants
Antidepressants
Antipsychotics
Beta-Blockers
Contraceptive Agents
Hormonal Agents
Immunosuppressants
Stimulant Agents
Thyroid Agents
Xanthine Oxidase Inhibitors
Vitamin A Analogs
Oncology Agents

Question 16

What are the most common hair loss in adult males? Why?

Answer 16

Androgenic alopecia due to DHT effect

Question 17

Can women get androgenetic alopecia?

Answer 17

Yes, due to excessive androgen levels presented as thinning hair on the mid frontal area (PCOS)

Question 18

What is alopecia areata?

Answer 18

Inflammation induced hair loss due to the presence of hair-follicle specific autoantibodies and exclammation mark hairs

Question 19

What are the diagnosis of hair loss?

Answer 19

1. Hair tug and pull test
2. PMH of medications
3. Suspected iron deficiency anemia (CBC, TIBC, ferritin, TSAT)
4. Female patients with alopecia (DHEA, testosterone)
5. Suspected chemotherapy-induced alopecia
6. Suspected case of trichotillomania (hair pulling disorder)
7. Suspected other systemic autoimmune conditions
   * SLE (i.e., ANA, ESR, CRP, autoantibodies)
   * Hypothyroidism or hyperthyroidism (i.e., TSH)

Question 20

What is a positive hair tug test?

Answer 20

Positive (+) tug test = >10% of hairs fracture

Question 21

What is the outcomes of a hair pull test?

Answer 21

Likely to extract more hairs in telogen phase than anagen phase:
Telogen hair -> “club-shaped”
Anagen hair -> “long sheath-shaped”

Question 22

What are the non pharm of hair loss?

Answer 22

1. Not appropriate to brush hair (>100 strokes/day) or massage scalp vigourously
2. Patients with alopecia should comb or brush their hair ONLY when dry

Question 23

What is the pharm tx for male pattern baldness?

Answer 23

1. Topical minoxidil
   * 2% and 5% topical colution
   * 5% topical foam
2. PO 5a reductase inhibitors

Question 24

Topical Minoxidil

Brand, Warning, Counseling

Answer 24

Rogaine
Warning: Pregnancy and lactation
* Use only on scalp, avoid contact with eyes, mouth, nose

Counseling:
* Administer to hair loss areas on the scalp ONLY
* Administer medication at least 2 hours before bedtime to reduce risk of contaminating bedding materials

Question 25

Types of 5a reductase inhibitors?

Answer 25

Propecia (finasteride)
Avodart (dutasteride) - off label

Question 26

5a reductase inhibitors

Dose, ADR,

Answer 26

Dose: Propecia (finasteride): 1 mg PO QD
ADR: Sexual dysfunction
Counseling: Swallow capsules (dutasteride) whole without chewing or opening, as opened capsules can cause oropharyngeal irritation
* Teratogenic and avoid handling crushed or broken tables or capsules (pregnant or child bearing age)

Question 27

What are the pharm for female pattern hair loss?

Answer 27

Topical minoxidil: 2% solution ONLY (5% not FDA approved)
* Avoid use in pregnancy & lactation

PO minoxidil: Avoid use in pregnancy & lactation

Oral 5α-reductase inhibitors: not FDA approved in females, avoid in pregnancy and childbearing age

Question 28

What is the tx of choice in alopecia areata? Others?

Answer 28

Intralesional corticosteroids (i.e., triamcinolone acetonide, hydrocortisone acetate)
Others:
* High-dose oral corticosteroids (i.e., prednisolone, dexamethasone)
* Topical corticosteroids (i.e., clobetasol propionate)
* Topical minoxidil
* JAK inhibitors (i.e., baricitinib, ritlecitinib, ruxolitinib, tofacitinib)
* IL-4 receptor-α antagonists (i.e., dupilumab)
* Immunosuppressive agents: (Azathioprine, Methotrexate)

Question 29

Jak inhibitors

Brand, BBW, Warnings, ADR, Counseling

Answer 29

Olumiant (baricitinib), Litfulo (ritlecitinib)
BBW: ≥50 years old with ≥1 cardiovascular risk factor increases MACE or mortality
Warning: GI perforations
ADR: GI perforation, elevated BP and lipids
Counseling: Do NOT administer with biologic DMARDs, potent immunosuppressants, or live vaccines.

Question 30

Pharm tx for hypotrichosis of eyelashes?

Answer 30

Prostoglandin analog: Latisse (bimatoprost) 0.03% drogs