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SOME COMMON CAUSES OF ALOPECIA DR RAKESH NEWAJ SPECIALIST DERMATOLOGIST MBBCh(Wits) FC derm (SA)

SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN

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Page 1: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN

SOME  COMMON  CAUSES  OF  ALOPECIA  

DR  RAKESH  NEWAJ  SPECIALIST  DERMATOLOGIST  MBBCh(Wits)  FC  derm  (SA)  

Page 2: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN
Page 3: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN

ALOPECIA  

•  Refers  to  a  decrease  in  density  of  hairs  on  the  scalp  or  body  

•  An  increase  in  hair  fall  coupled  with  a  decrease  in  the  diameter  of  the  hairs  

•  Becomes  apparent  when  more  than  25%  of  the  hairs  have  been  lost  

•  Affects  both  males  and  females    

Page 4: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN

ALOPECIA  

CICATRICIAL  

Page 5: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN

Non

-­‐  cicatricial   • Alopecia  areata  

• AndrogeneLc  alopecia  

• Telogen  Effluvium  

• TrichoLllomania  

Cicatricial   • TracLon  alopecia  

• FolliculiLs  decalvans  and  AKN  

• Hot-­‐comb  alopecia  

• Discoid  lupus  

• Frontal  fibrosing  alopecia  

Hair  shaR

 diso

rder  

• Beaded  hair  

• Pilli  torL  

• Trichorrhexis  invaginata(bamboo  hair)  

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Anagen    2-­‐6yrs  

Catagen    3  weeks  

Telogen  3  months  

Early  Anagen  

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DIAGNOSIS  

•  Good  history    including  onset,  systemic  symptoms,  family  history,  medicaLons  •  Trichoscopy  •  Hair  pull  test  •  Systemic  examinaLon  •  Swabs  •  Microscopy  of  the  hair  •  Biopsy  for  histology  

Page 8: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN

NON-­‐  CICATRICIAL    ALOPECIAS  

Page 9: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN

 ANDROGENETIC    ALOPECIA  (  Male  and  female  pa[ern  of  hair  loss)  

 •  GeneLcally  determined  sensiLvity  of  scalp  hair  follicles  to  adult  levels  of  androgens  

•  MiniaturizaLon  of  hairs  in  a  symmetric  pa[ern  •  More  common  in  men  and  increases  with  age  •  Women  who  develops    this  type  of  alopecia  in  the  perimenauposal    period  may  be  developing  hair  loss,  not  only  due  to  geneLcs,  but  also  due  to  alteraLons  in  androgen  metabolism  

Page 10: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN
Page 11: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN
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ANTIANDROGEN  THERAPY  

Classic  androgen  receptor  antagonist  

(prevents  testosterone  and  DHT  from  binding  to  their  

receptors)  

Peripheral    anGandrogens  

(alter  androgen  levels  in  the  hair  follicle)  

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PRODUCT   MECHANISM  OF  ACTION   DOSE  

Spironolactone   AnLandrogen,  reduces  testosterone  levels  and  compeLLve  AR  blocker  

100-­‐200  mg  by  mouth  daily  in  divided  doses  

Cyproterone  acetate  

AnLandrogen,  AR  blocker,        testosterone  levels  by  suppressing  luteinizing  hormone  and  follicle  sLmulaLng  hormone  

2mg  by  mouth  daily  generally  prescribed  together  with  an  oral  contracepLve    or  cyproterone  acetate  25-­‐50mg/d  on  days  1-­‐10  of  menstrual  cycle  

Finasteride   5-­‐alpha  reductase  blocker   0.2-­‐5mg  by  mouth  daily  

Minoxidil   Unknown-­‐  possible  anLandrogenic,  vasodilatory  and  anLinflammatory  effects  

5%  applicaLon  once  or  twice  daily  

Ketoconazole   Decreases  DHT  levels  at  the  hair  follicle   Shampoo  scalp  every  alt  days.  Wash  aRer  5mins  

Flutamide   AnLandrogen  compeLLve  AR  blocker   62.5mg-­‐250mg  by  mouth  daily  

Durasteride   5-­‐alpha  reductase  blocker    

0.25-­‐0.5mg  by  mouth  daily  

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PRODUCT   MECHANISM  OF  ACTION   TREATMENT  

Caffeine   Counteracts  testosterone  effects  on  hair  

Caffeine  loLon  and  shampoo,  potenLal  increase  in  hair  tensile  strength  and  numbers  

CimeLdine   H2  blocker,  peripheral  anLandrogen-­‐  blocks  binding  of  DHT  to  AR  

300g  by  mouth  5  Lmes  daily  

FerriLn   Unclear   Maintain  serum  ferriLn  level  >  40ng/ml.  

Melatonin   AnLandrogenic  effects  at  the  hair  follicle  

1mg  topical  compounded  in  alcohol  and  glycerin-­‐no  evidence  that  oral  suppliment  help  

BioLn   Reduces  carboxylase  enzymes  in  hair  roots  

No  clinical  trials  

Zinc   Unclear   Supplement  8-­‐15mg  by  mouth  daily  

Zinc  pyrithium  shampoo   Zinc  ions  have  anLinflammatory  and  anLoxidant  effects  and  inhibit  5-­‐alpha  reductase  in  vitro  

1%  pyrithione  shampoo  daily  

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TELOGEN  EFFLUVIUM  

•  Increased  shedding  of  normal  telogen  hairs  in  response  to  a  pathologic  or  physiologic  change  in  health  status  

•  A  chronic  form  with  no  discernible  precipitaLng  factor  is  observed  in  some  women  

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•  The  hair  loss  involves  the  enGre  scalp  

•  A  higher  percentage  of  telogen  hairs  (  more  than  20%)  

•  Telogen  hair  fibres  show  a  club-­‐shape  at  the  boSom  

•  Prognosis  is  rather  good  with  recovery  taking  place  within  months  to  years  

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CAUSES  OF  TELOGEN  EFFLUVIUM  •  Postpartum  •  Chronic  telogen  effluvium  •  Posiebrile  •  Severe  infecLons  •  Chronic  illnesses  •  Post  surgical  •  Hypothyroidism  and  other  endocrine  abnormaliLes  

•  Severe  stress  •  Crash  or  liquid  protein  diets/  starvaLon  •  Drugs:  ReLnoids,AnLcoagulants,  AnL-­‐thyroid,  anLconvulsants,  Beta-­‐blockers,chemotherapy  

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TREATMENT  

•  Minoxidil  5%  

•  TreLnion  soluLons  

•  Caffeine  shampoos  

•  A  good  history  and  eliminaLon  of  the  precipitaLng  factors    are  important  

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ALOPECIA  AREATA  

•  Non-­‐scarring  pa[erned  alopecia,  most  commonly  presenLng  as  circular  areas  of  alopecia  

•  Organ-­‐  specific  autoimmune  disease  involving  the  T-­‐cells  

•  Can  lead  to  total  scalp  hair  loss(  alopecia  totalis)  or  complete  scalp  and  body  hair  loss(  alopecia  universalis  

•  RelanLonship  with  other  autoimmune  diseases  

Page 20: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN
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Scalp  alopecia  areata  

Age  Topical  CorLcosteroids  5%  minoxidil  

Short  contact  anthralin  

ILCS+-­‐  Minoxidil+-­‐    

Topical  CorLcosteroids  

Scalp  involvement  

Topical  immunotherapy  DPCP  or  SADBE  

ConLnue     Excimer  laser  

Hair  regrowth  

ConLnue  as  needed  Add  ILCS  to  

refractory  patches    every  4  weeks  

Minoxidil  5%  CorLcosteroids  

under  occlusion  or  short  contact  anthralin  or  

systemic  therapy  

Hair  regrowth  

Hair  regrowth  

ConLnue  Short  contact  anthralin  

Minoxidil  soluLon  

<10yrs   >10yrs  

Good   Poor  

Good   Poor  

<50%   >50%  

6-­‐12months  

Good   ParLal  

Poor  

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TRICHOTILLOMANIA  

•  Self-­‐  induced  plucking  or  breakage  of  hair  

•  ORen  associated  with  a  psychologic  or  personality  disorder  

•  Histology  can  help  

•  Has  a  DSM  IV  classificaLon  

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CICATRICIAL  ALOPECIA  •  TracLon  alopecia  

•  FolliculiLs  decalvans/  dissecLng  folliculiLs  

•  Acne  keloidalis  nuchae  

•  Discoid  lupus  erythematosus  

•  Central    centrifugal  cicatricial    alopecia  (CCCA  or  Hot-­‐comb  alopecia)  

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TRACTION  ALOPECIA  

Page 25: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN

Cause  and  management  

•  Hair  styles  

•  Very  difficult  to  treat  

•  5%  Minoxidil  and  TreLnoin  

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DISSECTING  FOLLICULITIS,  FOLLICULITIS  DECALVANS  AND  ACNE  

KELOIDALIS  NUCHAE  

Page 27: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN

FOLLICULITIS  DECALVANS  

•  It  is  very  difficult  to  manage  as  inflammatory  process  damage  the  hair  roots  and  scars  are  formed  

•  Oral  anLbioLcs  (  rifampicin  with  or  without  clindamycin),  oral  zinc  sulphate,  oral  reLnoids  

•  Repeated  treatment  

Page 28: SOME%COMMON%CAUSES%OF% ALOPECIA%€¦ · %Alopeciaareata • Androgenec alopecia • Telogen Effluvium% • TrichoLllomania % • TracLon%alopecia • Folliculis decalvans%and% AKN

ACNE  KELOIDALIS  NUCHAE  Causes:    •  Shaving  of  Lghtly  curled  hairs  resulLng  in  the  emerging  hair  curling  

back  into  the  skin.  This  can  lead  to  inflammaLon  and  scars.  •  Constant  irritaLon  with  the  shirt  collars,  chronic  infecLon  of  the  

hair  roots  and  any  other  causes  of  irritaLon  of  the  scalp  

•   TREATMENT  OPTIONS  •  PrevenLon  of  lesions  -­‐  stop  irritaLon  of  the  scalp  and  stop-­‐  shaving  

the  scalp  •  TreLnoin  gel  and  corLcosteroid  •  Intralesional  steroids  •  Cryotherapy  regime  •  AnLbioLcs  use  for  infecLons  •  Punch  excision  •  Laser  hair  reducLon  and  scar  reducLon  •  Surgical  excision  and  repair        

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DISCOID  LUPUS  ERYTHROMATOSUS  

•  Commonly  involves  the  scalp  •  PASTE-­‐  Plugging,  Atrophy,  Scale,  Telangiectasia  and    Erythema  •  Scarring  is  permanent  •  Can  be  diagnosed  on  histology  •  Treatment    involves  potent  topical  corGcosteroids,  intralesional  steroids  and  

systemic  therapy(  anGmalarials,  thalidomide,  methotrexate)  

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HOT  COMB  ALOPECIA  CCCA  

•  Starts  in  the  central  scalp  region  and  increases  in  size  with  Gme  

•  Common  in  african  females  and  may  be  associated  with  hair  straitening  processes  

•  Shiny  with  a  burning  sensaGon  or  pruritus  in  the  area  of  hair  loss    

•  Diagnosis  can  be  made  on  histology  

•  Topical  corGcosteroids  and  tetracyclines  

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Contact  Details:  Dr  Rakesh  Newaj  Specialist  Dermatologist  MBBCh  (Wits)  FC  Derm  (SA)  www.dermatologistjohannesburg.com    266  Polaris  ave,  Waterkloof  ridge  Pretoria  Tel:  (+2712)-­‐7514001    Arwyp  medical  centre,  3rd  floor,  Medical  suites  Kempton  Park,  Johannesburg  Tel:  (+2711)-­‐9221565  

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Image  gallery  

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