Hair Disorders

Question 1

What are the hair disorders?

Answer 1

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

Question 2

What is the hair growth cycle?

Answer 2

Anagen - period of growth – 3 to 6 years
Catagen - period of transition - 2 weeks
Telogen- period of rest - 3 to 4 months

Question 3

What represents 90% of hairs?

Answer 3

anagen

Question 4

What represents 10% of hairs?

Answer 4

catagen and telogen

Question 5

What is alopecia areata?

Answer 5

discrete annular patches of hair loss without scalp disease or scaring

Question 6

What is hair loss of the entire scalp?

Answer 6

alopecia totalis

Question 7

What is hair loss on entire body?

Answer 7

alopecia universalis

Question 8

What do you see on exam of alopecia areata?

Answer 8

broken off hair, exclamation point hairs at periphery of lesions

Question 9

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

Answer 9

nail pitting, longitudinal striation

20% pt

Question 10

What associated disorders of alopecia areata?

Answer 10

Vitiligo
Familial multiendocrine syndrome
Thyroid disease
Stress

Question 11

What is the work up for alopecia areata?

Answer 11

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

Question 12

What is the treatments for alopecia areata?

Answer 12

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

Question 13

What does tacolimus and pimecrolimus do?

Answer 13

inhibit t lymphocyte activation

short term use only due to risk of malignancy

Question 14

Is there a cure for alopecia areata?

Answer 14

no, supplement with wigs, make up or psychological support

Question 15

What is androgenetic alopecia?

Answer 15

Progressive balding
Genetic predisposition
Androgen action

Question 16

Who gets androgenetic alopecia?

Answer 16

men > females

Question 17

How does androgenetic alopecia appear in men?

Answer 17

receding anterior hairline, bald spot on posterior crown

Question 18

How does androgenetic alopecia appear in females?

Answer 18

Diffuse loss of hair
Thinning appearance
Endocrine work up if indicated

Question 19

What is the pathology of AGA?

Answer 19

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

Question 20

What is the first treatment for AGA?

Answer 20

Topical minoxidil (Rogaine)  2% for women, 5% for men
Apply to scalp BID, if no regrowth in 4 months then d/c

Question 21

What is another AGA treatment?

Answer 21

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

Question 22

What are the side effects of finasteride?

Answer 22

Teratogenicity (in male fetus)

Erectile dysfunction and infertility

Question 23

Who is finasteride contraindicated in?

Answer 23

women and children

Question 24

What is the most extensive tx for AGA?

Answer 24

hair transplant

Question 25

What is Loss of hair in the Telogen (resting) phase?

Answer 25

Telogen effluvium

Question 26

What is telogen effluvium associated with?

Answer 26

``` Post partum Crash dieting Surgery Birth Control Pills High Fever Drugs - Anticoagulants, Heparin, Lithium, Accutane, Allopurinol, Propanolol, many others ```

Question 27

What is the treatment for telogen effluvium?

Answer 27

resurrance will grow back

Question 28

What is Loss of hairs in Anagen (growth) Phase?

Answer 28

anagen effluvium

Question 29

What causes anagen effluvium?

Answer 29

Chemotheraputic, Anticancer agents * Antimetabolite * Alkylating agents * Mitotic inhibitors * Doxorubicin

Question 30

What is the pathology of anagen effluvium?

Answer 30

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

Question 31

What is the treatment effluvium?

Answer 31

reassurance - reversible with time

Question 32

What is Trauma related to hair styling?

Answer 32

Traction alopecia

Question 33

What are causes of TA?

Answer 33

“Corn Rows” “Pony Tails” “Hair Extensions, Weaving”

Question 34

What is the treatment for traction alopecia?

Answer 34

``` Change hair style Early TA - reversible Early TA with anti-inflammatory -topical steroids Late TA - permanent hair loss Late TA - no treatment is available ```

Question 35

What are the causes of hair color defects?

Answer 35

Premature Canities (graying) Poliosis (patchy decrease in melanin) Albinism

Question 36

What is the age for whites with premature canitis?

Question 37

What is age for AA with premature canitis?

Question 38

What is the highest etiology of premature canitis?

Answer 38

GENETIC

Question 39

What do you need to work up for premature canitis?

Answer 39

Pernicious anemia B-12 deficiency Thyroiditis - Alters activity of melanocytes

Question 40

What is selective loss of pigmented hair?

Answer 40

rapid overnight graying

Question 41

What is Localized loss of hair pigment ?

Answer 41

poliosis

Question 42

What is poliosis etiology?

Answer 42

congenital/genetic or autoimmune

Question 43

What is the color of hair in albinism?

Answer 43

white or colorless

Question 44

What is albinism linked to?

Answer 44

genetic defect in melanin pathway, many different types

Question 45

What system does albinism also affect?

Answer 45

optic from hypopigmentation

Question 46

What do you see optically for albinism?

Answer 46

Photophobia iris transillumination Nystagmus pigment deficiency in the peripheral retina

Question 47

How do you dx albinism?

Answer 47

Hair bulb assays help to indicate the status of tyrosinase activity Multiple classifications (OCA 1, 1A, 1B, 2, 3; OA1, AROA) DNA sequencing

Question 48

What is the treatment for albinism?

Answer 48

Nitisinone hereditary tyrosinemiaa type 1 Investigational, not FDA approved

Question 49

What can cause folliculitis?

Answer 49

Bacterial Chemical irritation Physical injury

Question 50

What is the treatment for folliculitis?

Answer 50

``` Eliminate the cause Treat underlying infection: Most common (Staphylococcus Aureus) “hot tub” folliculitis (Pseudomonas aeurginosa) Topical antibiotics Systemic antibiotics ```

Question 51

What is hair grows out of follicle, then curls and repenatrates the skin?

Answer 51

pseudofolliculitis barbae

Question 52

What causes pseuedofolliculitis barbae?

Answer 52

Curly hairs African American men Close shaving

Question 53

What is the treatment for pseuedofolliculitis barbae?

Answer 53

discontinue close shaving - clip hairs, depilatories, laser treat like acne incision and removal of hair

Question 54

How long does it take for hair to grow back?

Answer 54

cancer - years to get full, see growth over time