Flashcards in Hair Disorders Deck (54)
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1
What are the hair disorders?
Alopecia Areta
Androgenetic Alopecia
Hair structure & color defects
Telogen Effluvium
Anagen Effluvium
Pseudofolliculitis barbae & folliculitis
2
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
3
What represents 90% of hairs?
anagen
4
What represents 10% of hairs?
catagen and telogen
5
What is alopecia areata?
discrete annular patches of hair loss without scalp disease or scaring
6
What is hair loss of the entire scalp?
alopecia totalis
7
What is hair loss on entire body?
alopecia universalis
8
What do you see on exam of alopecia areata?
broken off hair, exclamation point hairs at periphery of lesions
9
What do you see in nails of pt with alopecia areata?
nail pitting, longitudinal striation
20% pt
10
What associated disorders of alopecia areata?
Vitiligo
Familial multiendocrine syndrome
Thyroid disease
Stress
11
What is the work up for alopecia areata?
Thyroid studies
Serum Iron - Rule out Anemia
ANA - Rule out SLE
12
What is the treatments for alopecia areata?
Topical steroids
Intralesional injection of triamcinolone
tacrolimus (Protopic) and pimecrolimus (Elidel)
13
What does tacolimus and pimecrolimus do?
inhibit t lymphocyte activation
short term use only due to risk of malignancy
14
Is there a cure for alopecia areata?
no, supplement with wigs, make up or psychological support
15
What is androgenetic alopecia?
Progressive balding
Genetic predisposition
Androgen action
16
Who gets androgenetic alopecia?
men > females
17
How does androgenetic alopecia appear in men?
receding anterior hairline, bald spot on posterior crown
18
How does androgenetic alopecia appear in females?
Diffuse loss of hair
Thinning appearance
Endocrine work up if indicated
19
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
20
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
21
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
22
What are the side effects of finasteride?
Teratogenicity (in male fetus)
Erectile dysfunction and infertility
23
Who is finasteride contraindicated in?
women and children
24
What is the most extensive tx for AGA?
hair transplant
25
What is Loss of hair in the Telogen (resting) phase?
Telogen effluvium
26
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
27
What is the treatment for telogen effluvium?
resurrance will grow back
28
What is Loss of hairs in Anagen (growth) Phase?
anagen effluvium
29
What causes anagen effluvium?
Chemotheraputic, Anticancer agents
*Antimetabolite
*Alkylating agents
*Mitotic inhibitors
*Doxorubicin
30
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
31
What is the treatment effluvium?
reassurance - reversible with time
32
What is Trauma related to hair styling?
Traction alopecia
33
What are causes of TA?
“Corn Rows”
“Pony Tails”
“Hair Extensions, Weaving”
34
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
35
What are the causes of hair color defects?
Premature Canities (graying)
Poliosis (patchy decrease in melanin)
Albinism
36
What is the age for whites with premature canitis?
37
What is age for AA with premature canitis?
38
What is the highest etiology of premature canitis?
GENETIC
39
What do you need to work up for premature canitis?
Pernicious anemia
B-12 deficiency
Thyroiditis - Alters activity of melanocytes
40
What is selective loss of pigmented hair?
rapid overnight graying
41
What is Localized loss of hair pigment ?
poliosis
42
What is poliosis etiology?
congenital/genetic or autoimmune
43
What is the color of hair in albinism?
white or colorless
44
What is albinism linked to?
genetic defect in melanin pathway, many different types
45
What system does albinism also affect?
optic from hypopigmentation
46
What do you see optically for albinism?
Photophobia
iris transillumination
Nystagmus
pigment deficiency in the peripheral retina
47
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
48
What is the treatment for albinism?
Nitisinone
hereditary tyrosinemiaa type 1
Investigational, not FDA approved
49
What can cause folliculitis?
Bacterial
Chemical irritation
Physical injury
50
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
51
What is hair grows out of follicle, then curls and repenatrates the skin?
pseudofolliculitis barbae
52
What causes pseuedofolliculitis barbae?
Curly hairs
African American men
Close shaving
53
What is the treatment for pseuedofolliculitis barbae?
discontinue close shaving - clip hairs, depilatories, laser
treat like acne
incision and removal of hair
54
