Alopecia
Alopecia
Alopecia
Chairperson : Dr. Shahab Uddin Ahmed Chowdhury. Associate Professor & Head of the dept. Department of Dermatology, MMC. Dr. Mohammad Shoeb Khan, MD (Part-II) & Dr. Mohammed Saiful Islam Bhuiyan, MD (Part-II), FCPS (Part-II) Medical Officers, Department of Dermatology, MMCH. Speakers :
Organized by :
INTRODUCTION
Hairs are keratinized elongated
structures derived from invaginations of epidermis and project out from most of
RACIAL PREVALENCE :
Whites
are hairiest. Asians are least hairy and blacks fall in between.
TYPES OF HAIR
Morphologically :
Straight : Spiral : Helical : Wavy :
Asians , whites.
Blacks, whites.
Whites.
Whites.
Adult hair Vellus hair : fine hairs cover most of the body of youngsters and adults. Terminal hair: long, coarse, pigmented hairs with larger diameters.
NUMBER OF HAIRS
Scalp : about 1,00,000 hairs. Face : about 600 hairs /cm2.
FUNCTIONS
1. Protects body surface from external injury. 2. Helps in sensory function. 3. Psycho social importance. 4. Forensic importance. i. Identification of race, sex, age and religion. ii. Cause of death- can be determined. iii. Time of death- can be determined. 5. Assist thermo- regulation: mainly in lower animals.
DEVELOPMENT OF HAIR
Ectodermal origin1. Hair bud develops from epidermis and penetrates the dermis. 2. Hair shaft grows from cells in the
Mesodermal origin :
First hair to come is lanugo hair at eyebrow and upper lip at 12 weeks of gestation.
HAIR EMBRYOLOGY
HAIR CYCLE
It is believed that each hair follicle goes through 10-20 hair cycle in a life time. There are four phases1. Anagen : growing phase. 2. Catagen: involuting phase. 3. Telogen : resting phase. 4. Exogen : hair shedding phase.
Lasts for about 100 days. Club-shaped proximal end shed from the follicle during telogen or subsequent anagen.
Growth of a new anagen hair leads to shedding of any remaining telogen hair.
But new hair does not push out the hair from the previous cycle.
PIGMENTATION OF HAIR
Hair color is determined by melanocytes.
Melanocytes are present in the bulb. Melanocytes feed melanosomes mainly to the medulla and cortex. Melanocytic follicles produce melanin. eumelanin (dominant in brown-black hairs) . phaeomelanin (dominant in red-blond hairs)
ALOPECIA
CLASSIFICATION OF ALOPECIA
1. FOCAL HAIR LOSS Non-Scarring:
SCARRING ALOPECIA
A. Lymphocytic-
Abnormality of cycling
i. Alopecia areata. ii. Telogen effluvium. iii. Anagen effluvium. iv. Loose anagen syndrome.
B.
rickets.
ALOPECIA AREATA
Definition:
Rapid and complete loss of hair in one or most often several round or oval patches, usually on the scalp, bearded area, eyebrows, eye lashes and less commonly on other hairy areas of the body.
ALOPECIA AREATA
ALOPECIA AREATA
ALOPECIA AREATA(Contd.)
Epidemiology:
Approximately 1.7% of the population will
Exact cause is still unknown. It is an autoimmune disease- Mediated by the cellular arm (T- cell, macrophages ). - Modified by genetic factors (HLA-R4,DR11,DQ7)
Infections agents.
ETIOPATHOGENESIS
Trauma Neurogenic Inflammation Infections agents
Haematopoietic cell migration (T-cell) Production of follicular auto- antigen (Kerationcyte and melanocyte origin) Attack on melanogically active anagen fallicle
(incomplete revcovery).
iv. Normal recovery.
CLINICAL FEATURE
Rapid and complete loss of hair in one or several patches. Site Scalp, bearded area, eyebrows, eye lashes and less commonly other areas of body. Size Patches of 1-5 cm in diameter.
hair loss, there are broken hairs, whose distal ends are broader than the proximal end.
ALOPECIA UNIVERSALIS
ALOPECIA TOTALIS
Higher incidence of alopecia areata in patients of1. Atopic dermatitis. 2. Autoimmune disease * SLE * Thyroiditis. * Myasthenia gravis. * Vitiligo. 3. Lichen planus. 4. Down syndrome.
ASSOCIATED DISEASE
HISTOLOGY
Peribulbar, Perivascular and outerroot sheath infiltration with T-cells and
macrophages.
The follicular size are diminished and identified in more superficial dermis.
DIFFERENTIAL DIAGNOSIS
1. Tinea capitis. 2. Trichotilomania.
3. Secondary syphilis
4. Congenital triangular alopecia. 5. Alopecia neoplastica. 6. Early lupus erythematosus.
TREATMENT
Spontaneous recovery is extremely common
TREATMENT (CONTD.)
- High potent topical steroid used as first line therapy. - Intralesional steroid given at 4-6 weeks interval. - Systemic steroid (Short course, <8 weeks) alone or in conjunction with topical steroid.
TREATMENT (CONTD.)
If lack of response after several months therapy Topical 1% Anthralin cream - applied for 15-20 minutes and then shampooed off the treated side.
PUVA.
TREATMENT (CONTD.)
Contact sensitizer - Squaric acid dibutyle ester,
- Diphencyprone,
- Dinitrochlorobenzene.
Psychological support.
In extensive scalp hair loss- cosmetically expectable alternatives.
PROGNOSIS
Poor prognostic markerEarly onset (Prepubertal) Extensive involvement.
ANDROGENETIC ALOPICIA
ANDROGENETIC ALOPICIA
ANDROGENETIC ALOPECIA
Synonyms : Male Pattern alopecia, Male pattern baldness, Common baldness Secretarial alopecia. Definition : It is a very common, potentially reversible scalp hair loss that generally spares parietal and occipital areas (Hippocratic wreath) of the scalp.
Exact mechanism is still unknown. Hereditary (Probably autosomal dominant) & Androgen (specifically dihydrotestesterone)
ETIOPATHOGENESIS (Contd.)
Testesterone
5 R
Dihydrotesterone.
5R has two Isozyme, 5R1 and 5R2 5R1 ubiquitously distributed in skin particularly in sebaceous gland.
ANDROGEN
Androgen - androgen receptor complex in cytoplasm
transformation of receptor to expose DNA binding domain
binds to androgen response element of DNA Transcription and translation certain effector protein,
ETIOPATHOGENESIS (Contd.)
EFFECTS - Shortening of anagen and lengthening of telogen - Follicle become short and sclerosis of
CLINICAL FEATURE
Professors angle anterior hair line recedes backward on each side. Eventually entire top of the scalp become devoid of hair.
ETIOLOGY (CONTD.)
Adrenal cause - Congenital adrenal hyperplasia (androgenital syndrome) due to deficiency of 21 hydroxylase (most common) 11- hygroxylase. 3- hydroxysteroid dehydrogenase. - Tumor Adrenal adenoma Carcinoma.
CLINICAL FEATURE
Pattern of hair loss :
Christmas
progressive
tree
patternof
diffuse
density
and
and
reduction
slight recession.
TREATMENT
1. Topical Minoxidil (2% & 5%)
-non specific hair growth promoter affecting anagen induction. - M/A is not clear, its ca channel opener activity is important. 2. Systemic Finesteride (1mg daily).
TREATMENT (CONTD.)
3. In women spironolactone ( >100 mg daily). - Flutamide (250-500 mg bid or tid). - Cyproterone actate. 4. Surgical treatment- Micrograft & minigraft from non-androgen dependent site (occiput).
TELOGEN EFFLUVIUM
It is a reaction pattern to a variety of physical and mental stressors represents
Endocrine - Hypo- or hyperthyroidism. - Postpartum. - Peri- or postmenopausal state. Nutritional - Biotin deficiency. - Caloric deprivation. - Essential fatty acid deficiency. - Iron deficiency. - Protein deprivation. - Zinc deficiency.
Drugs Angiotensin-converting enzyme inhibitors. Anticoagulants. Antimitotic agents. Benzimidazoles. Beta blockers. Interferon Lithium
Physical stress
-
Psychological stress
Pathology
1. > 12% to 15% of terminal follicles are in telogen. 2. Follicle itself is not diseased. 3. No inflammation or dystrophic changes.
CLINICAL PRESENTATION
Lots of hairs coming out by the roots complained by patient. Diffuse hair loss with clinically perceptible thinning of hairs usually 3-5 weeks of inciting signal and shedding continue for about 3-4 month after removal of inciting cause. 150 to > 400 hair loss daily. Hair density may take 6-12 months to return to base line. Pull test. Clip test.
TREATMENT
No specific therapy. In majority cases hair will grow spontaneously within few month after removing inciting cause. In some patients with chronic telogen effluvium- 5% minoxidil solution, 70% success in man . - For Premenopausal women, 5% minoxidil solution + cyproterone acitate 50 mg from day 5 to 15 of menstrual cycle taken together with ethynnyl estradiol (0.035 mg/day).
TREATMENT (CONTD.)
For post menopausal women,
TRICHTILLOMANIA
A neurotic practice of plucking or breaking hair from scalp or eyelash resulting usually localized or widespread areas of alopecia
TRICHOTILOMANIA
TRICHOTILOMANIA IN A WOMEN
ALOPECIA SYPHILITICA
Typical motheaten appeorance on the occipital
involved.
It may be one or sole cutaneus manifestation of secondary syphilis. Treatment of syphilis may reverse the hair loss.