Hair LossWeek of April 14, 2003

1. Regarding normal hair growth, classify these statements as true or false:a. There is an average of 100,000 hairs on the human scalp, and daily loss of 100

hairs is considered normal.b. Scalp hair grows from 3-10 years before entering the telogen (resting) phase.c. Hair loss is often seen following the delivery of a child.

2. In scarring (cicatricial) alopecia, follicles are destroyed and hair never regrows. Label the following alopecia etiologies as scarring or non-scarring.a. Bacterial, fungal & viral infectionsb. Medications, including antineoplastic agentsc. Discoid lupus erythematosus & sclerodermad. Trichotillomania, and traction from hair braiding or tight rollerse. Systemic lupus erythematosus & syphilisf. Androgenic excessg. Radiation injuryh. Hypothyroidism, iron deficiency, crash diets, post-febrile infection

3. Regarding alopecia areata (AA), classify these statements as true or false:a. Alopecia aereata causes slow hair loss in irregular patterns.b. Life time risk of developing AA is 2%.c. Most patients experience a burning sensation or pruritus in the affected area.d. Ophiasis & Sisaipho are terms describing patterns of AA.e. Extensive (>40% of scalp) involvement indicates worse prognosis.

4. Classify the following statements as true or false:a. The etiology of most alopecia can be determined solely on a clinical basis.b. 5% strength minoxidil, in the treatment of male-pattern baldness, is most effective

on fronto-parietal hair loss.c. Women with female-pattern baldness can use standard dose minoxidil too.d. Hirsutism in women with male-pattern baldness can be treated with

spironolactone or dexamethasone therapy.

Hair Loss - AnswersWeek of April 14, 2003

1. Regarding normal hair growth, classify these statements as true or false:a. There is an average of 100,000 hairs on the human scalp, and daily loss of 100

hairs is considered normal.TRUE. If patients need reassurance, have them collect & count hairs lost daily.

b. Scalp hair grows from 3-10 years before entering the telogen (resting) phase.TRUE. Hairs that grow for long periods (with short resting periods) are mostsusceptible to interruptions of the growth cycle.

c. Hair loss is often seen following the delivery of a child.TRUE. During pregnancy, fewer hairs are shed. But after parturition, thepercentage of telogen hairs increases & hair is lost.

2. In scarring (cicatricial) alopecia, follicles are destroyed and hair never regrows. Label the following alopecia etiologies as scarring or non-scarring.a. Bacterial, fungal & viral infections

SCARRING. Deep cellulitis, trichophyton sp., and herpes zoster all produceinflammatory changes and often irreversible alopecia. Very mild infections anduncomplicated tinea capitis are non-scarring.

b. Medications, including antineoplastic agentsNON-SCARRING. Frequently implicated meds include ß-blockers, TCA’s,anticonvulsants, coumadin, allopurinol, verapamil, indomethacin, haldol, vit A,OCP’s, indomethacin, sulfasalazine

c. Discoid lupus erythematosus & sclerodermaSCARRING.

d. Trichotillomania, and traction from hair braiding or tight rollersNON-SCARRING. The pattern of hair loss depends on the styling or site ofremoval. Short broken hairs can be seen. Will eventually SCAR if chronic.

e. Systemic lupus erythematosus & syphilisNON-SCARRING.

f. Androgenic excessNON-SCARRING. Female-pattern baldness is similar to male-pattern, but hairloss is more diffuse. If male-pattern is seen in a female, it is often accompaniedby hirsutism (and virilization if severe). PCO & hyperprolactinemia are commoncauses. Ovarian and adrenal tumors produce frank virilization. DHEA & freetestosterone levels are increased.

g. Radiation injurySCARRING.

h. Hypothyroidism, iron deficiency, crash diets, post-febrile infectionNON-SCARRING.

3. Regarding alopecia areata (AA), classify these statements as true or false:a. Alopecia aereata causes slow hair loss in irregular patterns.

FALSE. It causes rapid hair loss in circular patterns. Pathognomonically,“exclamation point” hairs are often present. Positive “pull test” from theperiphery of a patch indicates active disease & further pending hair loss.

b. Life time risk of developing AA is 2%.TRUE. Etiology is unclear but genetic & autoimmune factors dominate.

c. Most patients experience a burning sensation or pruritus in the affected area.FALSE. About 14% report this, suggesting an etiologic role for perifolicularvasculature or innervation.

d. Ophiasis & Sisaipho are terms describing patterns of AA.TRUE. Ophiasis describes hair loss localized to the sides and lower back of thescalp. Sisaipho patterns spare the sides and lower back of the scalp. Alopeciatotalis & alopecia universalis describe 100% scalp & 100% body hair loss.

e. Extensive (>40% of scalp) involvement indicates worse prognosis.TRUE. If localized, AA is usually self-limited and resolution occurs with a fewmonths with or without treatment. If extensive, treatment involves minoxidil andcorticosteroid injections. Also used in therapy: topical immunotherapy, anthralininjections, PUVA, tacrolimus. AT/AU rarely responds to any therapy.

4. Classify the following statements as true or false:a. The etiology of most alopecia can be determined solely on a clinical basis.

TRUE. Confirmation of systemic or nutritional diseases should be sought.Rarely, scalp biopsy & telogen counts are indicated.

b. 5% strength minoxidil, in the treatment of male-pattern baldness, is most effectiveon fronto-parietal hair loss.FALSE. Only vertex balding is reversed/slowed by minoxidil. Finasteride(Propecia) allows better response in the fronto-parietal region.

c. Women with female-pattern baldness can use standard dose minoxidil too.FALSE. 2% strength should be used to prevent facial hair growth.

d. Hirsutism in women with male-pattern baldness can be treated withspironolactone or dexamethasone therapy.TRUE. Hirsuitism often improves before the alopecia does.