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HAIR DISORDERS Dr. Naif Al-Shahrani, M.D College of Medicine Salman Bin Abdulaziz University

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Page 1: HAIR DISORDERS - PSAU · HAIR DISORDERS • HAIR LOSS(alopecia) alopecia areata androgenetic alopecia telogen eff. anagen eff. trichotillomania • HAIR EXCESS hirsutism

HAIR DISORDERS

Dr. Naif Al-Shahrani, M.D

College of Medicine

Salman Bin Abdulaziz University

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HAIR DISORDERS

• HAIR LOSS(alopecia)

alopecia areata

androgenetic alopecia

telogen eff.

anagen eff.

trichotillomania

• HAIR EXCESS

hirsutism

hypertrichosis

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Introduction & definition

Alopecia = HAIR LOSS

Basic hair anatomy and Physiology

Hair growth is very dynamic

Vellus and Terminal hair

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How many hairs in the body?

5 millions hairs

100,000 in the scalp

Growth rate?

0.3mm/day for scalp hair

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1

2

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Alopecia

Scarring

(Irreversible)

Non-Scarring

(Reversible)

. X

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scarring

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Androgenetic Alopecia

(Male and Female Pattern Hair Loss)

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Male Pattern Hair Loss

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Female Pattern Hair Loss

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Androgenetic Alopecia affects up to 50%

of males and 40% of females

Autosomal dominant with variable

penetrance

85% : +ve family history

Role of androgens in the pathogenesis:

Androgenetic Alopecia

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5 ALPHA Reductase

Testosterone

DihydorTestosterone

(Active)

X Fenastride

Systemic Treatment

Miniaturization of

Terminal Hairs

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Topical Treatment

Minoxidil 2% and 5% Solution

Systemic

Finastride 1 mg daily

Surgical

Hair transplantation

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Fenastride

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Minoxidil 5%

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Minoxidil 2% and 5%

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Alopecia Areata

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30%: +ve Family history

High rate of self recovery

Role of immune system in the pathogenesis

Alopecia Areata

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-Clinical presentation;

Uninflammed skin

-Sites:

-Nails:

-Prognosis: limited vs extensive

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Treatment

No treatment

Topical steriod

5% Topical minoxidil

Intralesional Corticosteroids

Skin Sensitizers(Anthralin)

Oral steriods

Iv steriod pulse therapy

Hair transplant ?????

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Skin Sensitizers

Immune modulating Rx

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Anagen effluvium

Cause: cytotoxic chemotherapy

Sudden and severe alopecia

Mostly reversible but not always

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Telogen effluvium

Common and Non-specific

Acute or chronic

causes:

Anemia

Postpartum

postfebrile

drugs

Weight loss (crash dieting)

Acute blood loss

postsurgical

Low iron

Others

Reversible (but may be become chronic)

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Trichotillomania

• Obsessive compulsive disoder

• Pulling of hair

• Asymmetrical areas

• Treatment:

Behavioural therapy

SSRI

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Fungal Scalp Infections(tinea capitis)

Child had contact with animals.

-Scaly or inflammed alopecia or Kerion

- siblings may also be affected.

-Wood’s Light

-Scalp scrapings and hairs should be

examined microscopically, and cultured to

demonstrate the fungus.

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Fungal scalp infections

Treatment:

-Oral antifungal( griseofulvin or terbinafine or

itraconazole)

-Hair regrow normally unless a kerion has led

to scarring.

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NO

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Chronic Discoud lupus

-patchy and scaly alopecia ,

- follicles plugged by scales and

erythematous advancing margin.

- scaring process => permanent alopecia

-Treatment of early lesions

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Hirsutism

- Hirsutism is excess growth of androgen-

dependent hair in a male pattern

- Hypertrichosis is excess growth of hair in

non androgenic pattern.

Seen in both sexes but hirsutism is restricted

to females.

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Hirsutism

In female pt hair grows in the beard area,

around the nipples, and in a male pattern on

the abdomen.

-Hirsutism can cause great distress to a

healthy woman and lead to psychological

disturbances with depression.

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Causes

Adrenal: Cushing’s syndrome, virilizing tumours, congenital adrenal hyperplasia

Pituitary: acromegaly

Ovarian: Plycystic ovaries, virilizing tumours, gonadal dysgenesis

Iatrogenic: due to androgenic drugs

Idiopathic: Target or end-organ hypersensitivity( the commonest cause).

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Investigation

To exclude the underlying, treatable causes

-Although many tests of adrenal, ovarian, and

pituitary function are available, the young

woman who is menstruating regularly, and

has had one or more successful pregnancies,

requires little endocrine assessment.

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Full endocrine assessment is, however

essential in patients with amenorrhoas, scanty,

irregular periods, or with signs of excess

androgen stimulation.

Signs of virilization?

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Laser

Diane

treatment

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Hypertrichosis

-Either congenital or acquired

-Congenital associated with melanocytic naevi, while

lumbosacral hypertrichosis (faun tail) should alert

the pediatrician or obstetrician to the possibility of

spina bifida occulta.

-Acquired drug induced

Endocrine disorder like thyroid dysfunction

Anorexia nervosa

Drugs

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Hypertrichosis

Drug causing hypertrichosis include :

cyclosporine, penicillamine, and the

psoralens. Minoxidil

If the offending drug is withdrawn, the

excessive hair growth will cease.

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