Follicular Diseases

Question 1

What follicular disease is this characteristic of?

Definition

Etiology

Pathophysiology

Answer 1

• 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​​​

Question 2

What are the two main causes of hirsutism?

Answer 2

1. PCOS=viralization, high serum androgens, menstrual irreg.
2. Idiopathic/familial=normal ovulatory function & circulating androgens, no menstrual irregularitis

Question 3

Clinical features and how diagnosis is determined of hirsutism?

Answer 3

• 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

Question 4

What is this an example of?

Answer 4

Telogen Effluvium

Question 5

What is this an example of?

Answer 5

Telogen Effluvium

Question 6

Definition of Telogen Effluvium

Occurrance

Answer 6

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.

Question 7

History of Telogen Effluvium

Answer 7

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

Question 8

What is the general appearance of Telogen Effluvium?

What is a simple test for it?

Answer 8

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

Question 9

How is Telogen Effluvium diagnosed and what tests could be run?

Answer 9

usually based on Hx and PE

CBC count and iron levels
TSH
hair collections

Question 10

What is the treatment for Telogen Effluvium?

Answer 10

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

Question 11

What is this an example of?

Answer 11

Traumatic Alopecia

Question 12

What is this an example of?

Answer 12

Traumatic Alopecia

Question 13

What is Traumatic Alopecia?

Answer 13

Alopecia cause by mechanical traction or chemical trauma

Question 14

Where is traumatic alopecia often found?

Answer 14

In African American females

Question 15

What are the two ways traumatic alopecia occurs?

Answer 15

Mechanical traction: excessive traction for prolonged periods leads to conversion of the anagen to the telogen phase.

Chemical trauma: chemical overprocessing reduces hair strength.

Question 16

What are the common symptoms of traumatic alopecia?

Answer 16

May complain of itching or dandruff

Question 17

What can be seen in an examintation of traumatic alopeica?

Answer 17

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.

Question 18

How to diagnose traumatic alopeica?

Answer 18

Based on Hx and PE

Question 19

Treatment of traumatic alopecia

Answer 19

early recognition and discontinuation of traction/chemical trauma

Question 20

Prognosis of Traumatic Alopecia

Question 21

Definition

Answer 21

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

Question 22

Pathogenesis

Answer 22

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

Question 23

History

Answer 23

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.

Question 24

Exam and Dx

Answer 24

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

Question 25

Prevention

Answer 25

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

Question 26

Treatment and Complications

Answer 26

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.

Question 27

What is hypertrichosis?

Answer 27

excessive hair growth beyond normal limits for age, sex, race in non-androgen sensitive areas

Question 28

Where is hypertrychosis common?

Answer 28

- Can involve entire body - spares palms and soles

Question 29

What can cause hypertrichosis?

Answer 29

- Rare; can be congenital or acquired - usually drug induced - can be caused by hypothyroidism, anorexia, malabsorption...

Question 30

Treatment for hypertrichosis?

Answer 30

Treat the underlying problem!

Question 31

The common cause of these lesions (2 different lesions shown)

Answer 31

Furuncle (L) and Carbuncle (R) S. aureus

Question 32

Definition of Furuncle

Answer 32

a deep inflammatory nodule involving the hair follicle, usually following an episode of folliculitis

Question 33

Definition of Carbuncle

Answer 33

a series of abscesses in the SQ tissue that drain via hair follicles

Question 34

Clinical features of

Answer 34

Furuncle/Carbuncle nodular lesions, very painful, usually drains pus spontaneously systemic symptoms uncommon with furunculosis fever in deeper infections (carbuncles)

Question 35

Treatment of

Answer 35

Furuncle/Carbuncle warm compresses to promote spontaneous drainage antibiotic treatment directed against S. aureus surgical drainage for severe infections

Question 37

What can cause folliculitis?

Answer 37

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

Question 38

What things can cause folliculitis?

Answer 38

History of occlusive dressings, sweating and friction frequent shaving

Question 39

How do you prevent folliculitis?

Answer 39

avoid shaving irritated skin, and avoid close shaving change disposable razors periodically good personal hygiene

Question 40

What is the treatment for folliculitis?

Answer 40

Antibacterial soaps topical antibiotics or antifungals systemic antibiotics for severe or widespread infections

Question 41

what should you check for/treat if someone has recurrent/chronic folliculitis?

Answer 41

nasal colonization of staph aureus treat with mupirocin (bactroban) ointment in nasal vestibule x 5 days