disorders of hair follicle

7/29/2019 Disorders of Hair Follicle

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AKORAH UCHE.


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OUTLINE

INTRODUCTION

ANATOMY

CLASSIFICATION

CLINICAL FEATURES

INVESTIGATIONS

MANAGEMENT CONCLUSION


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INTRODUCTION

Hair follicle disorders are very common

cases in dermatological clinics. They

present in various forms. Loss of hair or

excessive hair growth causepsychological distress to the patients.


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ANATOMY

Humans have 5million hair follicles at birth.

No follicle is formed after birth, size changes

under the influence of androgen. Hair is

found on every part of the body except onthe palms, soles, penis, distal phalanges.


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Anatomy contd

The cuticle protects and holds the cortex

cells together. The pigment in hair shaft

is produced by melanocytes.

Mature hair follicle contains a hair shaft,2 surrounding shealths and a bulb

The hair follicle is divided anatomically

into 3 sections The infundibulum........extend from the

surface to sebaceous gland


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The Isthmus........from duct down to

insertion of erector muscle.

The inferior segment.......muz insertion

to base of matrix.

Hair shaft has 3 layers, an outer cuticle,

cortex and medulla. All of which are

composed of dead protein..


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TYPES OF HAIR

Hair varies in length (short or long),

thickness, colour and appearance (curly or

straight)

Hair can be: 1. Lanugo hair- fine hair covering the

fetus but shed one month before birth

2. Vellus-fine short unmedullated haircovering much of the body, replaces

lanugo. Adult form of lanugo hair


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Types of hair contd

3.Terminal- long coarse medullated hair

seen on scalp, axilla, beard and pubic

hair.

Hair grows 0.35mm per day, 1-2cm permonth

6inches per year.


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Physiology

Cycle of hair follicles depends on theinteraction of the follicular epithelium withthe dermal papilla.

Stems cells migrate out of the follicle and

regenerate the epidermis after injury Rapidly proliferating matrix cell in hair bulb

produces the hair shaft

The rigid inner root sheath compress the

matrix cells into their shape. The shape ofthe inner root sheath determines the shapeof hair


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Hair cycles

3 phases

Anagen (growing) phase......... 90-95%

catagen(transitional) phase.....


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Patchy loss scarring/Cicatrical

Lichen planopilaris

Discoid lupus erythematosus

Folliculitis decalvans

Pseudopelade

Follicular degeneration syndrome

Trauma Infection folliculitis

Perifolliculitis capitis abscensens


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Patchy loss non scarring

Alopecia localized/areata

Tinea capitis

Traction alopecia

Trichotillomania

Syphilis

Hair breakage Iron def

drugs


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Diffuse

Telogen effluvium

Androgen Alopecia

Androgenetic Alopecia

Systemic disease (thyroid,iron

def,SLE,Dermatophysis)

Physiologic ..... Neonate, postpartum,

Common male baldness


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EFFLUVIUM

Anagen effluvium is loss of hair from

follicles in their growing phase.it is due

to insult to metabolic and follicular

reproductive apparatus on the hair. Cancer chemotherapy and radiotherapy

thallium and arsenic poisoning are the

cause. Only hair left are those in thetelogen phase


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Telogen effluvium

Premature termination of anagen phasecause abnormal no of hairs to enter restingphase.

The hair follicle is not disease but has itsbiologic clock reset

Causes are Febrile illness, postpartum loss,emotional and physical trauma, poor diet

Drugs e.g Aminosalicylic,amphetamine,bromocriptine,cimetidine,captopril,danazol, propanolol,enapril,levodopa.


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treatment

Superfacial folliculitis may heal

spontaneously within 2wks

Antibiotic ointment Bacitracin, mycitracin

Bactrobam(mupirocin)

Dicloxacillin or cephalosporin in Deep

folliculitis

Electric razors preferably


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Trichotillomania

This is usually seen in children who are

emotionally disturbed and nervous. They

compulsorily pull out their hairs. It is

commonly seen in secondary andtertiary students that pull their hair while

reading.


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Traction Alopecia

This results from chronic tension on hair

shaft due to certain hair styles, braids,

hair rollers, hot straigthening combs.

Traumatic marginal alopecia occur inNigerian women who braid their hair and

from traumatic friction from hair ties.


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Alopecia Areata

It is a common disease characterised byrapid total hair loss in a rounded welldefined area

in people less than 40years, both sexesare equally affected.

Aetiology is unknown but is usuallyassociated with an autoimmune disorder

like vitiligo, Hashimotos thyroiditis .Sometimes, stress is said to be a cause.Follicles prematurely enter the catagenand telogen phase.


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Clinical features of Alopecia

areata

The lesion is asymptomatic

Px notices a patch devoid of hairs

Scalp looks normal with visible hair

follicles but devoid of hair.

They may be erythema or faint depression

An actively extending bald patch shows at

periphery, broken off hairs which taper to asmall bulb (exclamation mark hairs)


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Exclamation mark hairs


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Alopecia totalis ......... Whole scalp

Alopecia universalis........ Whole body

Alopecia recovers spontaneously but

relapses are common Prognosis is bad in both.

Earlier age of onset, the poorer the

diagnosis Nail changes (nail plate is pitted like a

thimble) shows a higher severity.


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TREATMENT

Corticosteroids

Photochemotherapy

Contact allergen therapy

Minoxidil

Inosiplex(isoprinosine)


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Folliculitis

This is a bacterial infection with irritation

of the affected hair follicles

Folliculitis occurs when the hair follicles

are damaged by shaving, clothfriction,scratching or obstruction

The lesions are pustular around the hair

The infected hair can easily be removedbut new papules develop.


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Sites

Occurs anywhere on the body at anyage and usually last for few days orweeks

Occurs in the bearded area in men,scalp, upper trunk, buttocks, thighs andgroin.

Superfacial folliculitis affects the upper

part of hair follicle n Deep affects thewhole hair.

Deep folliculitis is more painful.


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FOLLICULITIS


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Folliculitis barbae


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Folliculitis


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Folliculitis Decalvans

This presents as pruritic or burning

follicular pustules and papules.

Spreads peripherally

It is idiopathic

Old lesion heals leaving scarring

alopecia

It does not respond to treatment


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Perifolliculis capitis abscedens

et suffodiens

A chronic persisting disease seen

almost exclusively in Male blacks

Aetiology is both pathogenic and non

pathogenic

Often associated with acne vulgaris or

hidradenitis suppurativa

The lesions present as numerous firmoften painless 5-10mm nodules


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Contd

Affects the occiput and the vertex

Sinus tract draining purulent material

may form in severe cases

The hairs are loose and easily plucked

off from the lesions unlike Dermatitis

papillaris capillitii

Severe scarring alopecia occurs in latestage.


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Hypertrichosis

Implies excessive hair or

Hair on abnormal regions

Hirsutism is androgen controlled

excessive hair growth CAUSES

1. CONGENITAL- which can be

Generalised-dog or ape man Localised- hairy naevus, spina bifida


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ACQUIRED

Localised- use of irritants

Generalized-endocrine (virilism),

nutritional (anorexia nervosa),

idiopathic(hereditary or familial)


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Treatment

X-ray epilation

low dose oxytetracyncline

Warm water shampoo with selenium

sulphide daily

Topical antibiotics

Benzoyl peroxide or erythromycin

Antibiotics and topical steroids

combination


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MANAGEMENT OF

HYPERTRICHOSIS

Take a history

Examination of the whole body

Endocrine Tumour........ Surgery

hormonal ........ GonadotrophinsAnorexia nervosa....... Improve on

nutrition

Removal of the hair viaelectrolysis/thermolysis, bleaching usinghydrogen peroxide


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Keratosis pilaris

It is a condition in which the hair follicle

become blocked with hair and dead cells

from outermost layer of skin(epidermis).

The follicles reddened and inflamebumps (papules develop). Papules of

KP usually occur on the upper arms,

thighs but also occur on the face buttock

and back.


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Causes and Risk Factors

Keratosis pilaris (KP) is a hereditarydisorder. One can inherit it from one orboth parents. KP stems fromoverreproduction of keratinocytes, the cellsthat manufacture the protein keratin, animportant skin component (calledhyperkeratosis). Some researchers

describe KP as one of a whole spectrum ofdisorders, rather than as an independentdisease.


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KP is more prevalent among children and

adolescents and less common in adults. It

seems to improve after puberty. Individuals

with dry skin and eczema (skin disorder)tend to have more severe cases. The

condition improves during warm summer

months and worsens during the winter.

Rx ..... Rub off top layer with loofah spongeand fruit acid cream e.g salicylic aid
http://www.dermatologychannel.net/dermatitis/index.shtmlhttp://www.dermatologychannel.net/dermatitis/index.shtml


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Trichomycosis

It is an asymptomatic infection of the

axillary or pubic hair caused by a

corynebacterium. The hair shaft

becomes coated with the adherentyellow firm secretion. It may be red or

black occcasionally.

Hyperhidrosis is often present. Hair isshaved and hyperhidrosis is controlled

with antiperspirant.


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Conclusion

The psychological aspect of hair

disorders have to be well managed

through adequate counselling and

artificial aids used in very severe casesof hair loss.


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THANKYOU!!!

disorders of hair follicle

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