Hair Disorders Flashcards by Kayla Lowery

What are the hair disorders?

Alopecia Areta
Androgenetic Alopecia
Hair structure &amp; color defects
Telogen Effluvium 
Anagen Effluvium
Pseudofolliculitis barbae &amp; folliculitis

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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

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What represents 90% of hairs?

anagen

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What represents 10% of hairs?

catagen and telogen

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What is alopecia areata?

discrete annular patches of hair loss without scalp disease or scaring

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What is hair loss of the entire scalp?

alopecia totalis

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What is hair loss on entire body?

alopecia universalis

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What do you see on exam of alopecia areata?

broken off hair, exclamation point hairs at periphery of lesions

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What do you see in nails of pt with alopecia areata?

nail pitting, longitudinal striation

20% pt

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What associated disorders of alopecia areata?

Vitiligo
Familial multiendocrine syndrome
Thyroid disease
Stress

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What is the work up for alopecia areata?

Thyroid studies
Serum Iron - Rule out Anemia
ANA - Rule out SLE

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What is the treatments for alopecia areata?

Topical steroids
Intralesional injection of triamcinolone
tacrolimus (Protopic) and pimecrolimus (Elidel)

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What does tacolimus and pimecrolimus do?

inhibit t lymphocyte activation

short term use only due to risk of malignancy

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Is there a cure for alopecia areata?

no, supplement with wigs, make up or psychological support

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What is androgenetic alopecia?

Progressive balding
Genetic predisposition
Androgen action

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Who gets androgenetic alopecia?

men > females

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How does androgenetic alopecia appear in men?

receding anterior hairline, bald spot on posterior crown

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How does androgenetic alopecia appear in females?

Diffuse loss of hair
Thinning appearance
Endocrine work up if indicated

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What is the pathology of AGA?

Circulating androgens are converted to dihydrotestosterone (DHT) by 5 alpha reductase (5R)in the hair follicle.
In AGA there is an increase of (5R) therefore an increase of DHT.
DHT causes an increase in the telogen phase and a shortening of the anagen phase

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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

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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

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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 antibiotics ```

What 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