ALOPECIA & VITILIGO GHADA BINSAIF, MD ASSISTANT PROFESSOR & CONSULTANT DERMATOLOGIST KSU & KKUH ALOPECIA Hair Types Vellous Vellous Terminal Terminal Androgen dependant terminal Androgen dependant terminal Hair Cycle Hair growth is very dynamic How many hairs in the body? 5 millions hairs; 100,000 in the scalp Growth rate? 0.3mm/day for scalp hair Alopecia Scaring (Irreversible) None Scaring (Reversible) Alopecia Areata Sudden hair loss ( localized or generalized) Alopecia Areata affects up to 2% 75% : Self recovery, 2-6 m Causes : 30%: +ve Family history autoimmune Clinical findings Well demarcated Well demarcated Exclamation point Exclamation point Normal scalp Normal scalp Nail: pitting, ridges Nail: pitting, ridges Types of alopecia areata - Localized partial - Localized partial - Localized extensive - Localized extensive - Alopecia ophiasis - Alopecia ophiasis - Alopecia totalis - Alopecia totalis - Alopecia universalis - Alopecia universalis Bad prognostic factors Young age Young age Atopy Atopy Alopecia totalis, universalis, ophiasis Alopecia totalis, universalis, ophiasis Nail changes Nail changes Diagnosis Clinically Clinically H/E: sworm bees H/E: sworm bees Treatment 1. Observation 2. Intralesional Corticosteroids Skin Sensitizers Anthraline Diphencyclopropenone (DPCP) others Others Topical steroids Systemic Steroids Cytotoxic Rx Phototherapy Minoxidil Hair Transplant ( NO) Androgenetic Alopecia (Male and Female Pattern Hair Loss) Androgen dependent loss of scalp hair Androgen dependent loss of scalp hair Androgenetic Alopecia affects up to 50% of males and 40% of females Androgenetic Alopecia affects up to 50% of males and 40% of females Autosomal dominant with variable penetrance Autosomal dominant with variable penetrance 85% : +ve family history 85% : +ve family history 5 ALPHA Reductase Testosterone DihydorTestosterone (Active) Miniaturization of Terminal Hairs Male Pattern Hair Loss Female Pattern Hair Loss Treatment Topical: Neoxidil 2%- 5% solution Topical: Neoxidil 2%- 5% solution Systemic: Systemic: Fenastride Fenastride Spironolactone Spironolactone Anagen effluvium Telogen effluvium Telogen effluvium Telogen effluvium Chronic alopecia Reversible (but may be become chronic) 3-4 months Causes Drugs associated with telogen Effluvium Treatment Remove or treat the cause Remove or treat the cause Minoxidil 2% Solution Minoxidil 2% Solution Anagen effluvium Always related to cytotoxic chemotherapy Always related to cytotoxic chemotherapy Acute and severe alopecia Acute and severe alopecia Mostly reversible but not always Mostly reversible but not always Scaring Alopecia SLE DLE SLE DLE LP LP Sarcoidosis Sarcoidosis Leprosy Leprosy Kerion - Favus Kerion - Favus Trauma Trauma Vitiligo -Acquired cut. depigmentation -Kobner phenomena Causes - Genetic - Autoimmune dis. - Neural Natural coarse? Varied Varied Why? Loss of normal melanocytes Dopa stain Special studies T4, TSH, FBS ANA/Ro/La (prior to PUVA) TREATMENT Sunscreen (sunburn, koebnerization, tanning) Limited: Class 3 topical GC Topical Tacrolimus Topical PUVA Excimer laser Resistant, Stable of 2 years : Surgical GeneralizedPhototherapyUniversal: Bleaching agent