hair diseases

for knowledge/ dermatological lessons , specally skin appendage disorders /hair disorders .

1. facebook page: Dr. ABDULLAH ABDUKADIR YUSUF duceysane Adbullah raafic Expert presenter To HAIR DISORDERS

2. Hirsutism Definition : Hirsutism is defined as excessive terminal hair growth in androgen-dependent areas of the body in women, which grows in a typical male distribution pattern Epidemiology: Ethnic differences – Asian women tend to have little body and facial hair, while Middle Eastern, Mediterranean, and East Indian women have moderate amounts The condition is often associated with a loss of self-- esteem . Symptoms : Irregular period Male-pattern baldness Acne

3. Etiology and Pathogenesis: Women with excessive growth of terminal hairs in a “ male pattern” due to ANDROGEN OVERPRODUCTION (ovaries or adrenal glands) or increased sensitivity to androgens Ovarian origin – PCOS, insulin resistance, ovarian Tumors. Diagnose: clinically Laboratory testing Sex hormone-binding globulin level Image – CT/MRI abdomen or pelvis Hirsutism

4. Management Cosmetic methods Physical methods of removing hair (shaving) Permanent hair reduction (laser and intense pulsed light) Non-pharmacological methods Lifestyle therapies are first-line treatments in women with PCOS Pharmacologic management Oral Contraceptives Gonadotropin-Releasing Hormone Agonists ( GnRH -A) Hirsutism

5. Suppression of androgen synthesis: Androgen antiagonist : Spirolucton 100-200 mg. Ketoconazole 400 mg Finasteride 2.5 mg daily Medroxyprogeste one acetate : Dose: 150 mg intramuscularly every 3 months. Indications: severely androgenized patients refractory to other therapies. Corticosteroids: Indications: severe cases of adrenal hyperplasia (CAH). Hirsutism

6. Alopecia areata ( spot baldness) Definition AA is a condition in which hair is lost from some or all areas of the body .  Psychological stress may result. Epidemiology The condition affects 0.1 %– 0.2% of the population, occurs equally in both males and females.  Patients also tend to have a slightly higher incidence of conditions related to the immune system, such as  asthma , allergies,  atopic  dermatitis, and  hypothyroidism.

7. Etiology Cause is still unknown It is an autoimmune disease Modified by genetic factors Pathogenesis Hair matrix cells are impaired temporarily for unknown reason. Theories include nutritional failure, heredity and mental stress ; however, the pathogenesis is unknown. Some cases are accompanied by autoimmune. Alopecia areata ( spot baldness)

8. Hair may also be lost more diffusely over the whole scalp, in which case the condition is called diffuse alopecia areata. Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere on the head. Alopecia areata multilocularis refers to multiple areas of hair loss. Ophiasis  refers to hair loss in the shape of a wave at the circumference of the head. The disease may be limited only to the beard, in which case it is called alopecia areata barbae . If the person loses all the hair on the scalp, the disease is then called  alopecia areata totalis If all body hair, including  pubic hair , is lost, the diagnosis then becomes  alopecia areata universalis Alopecia areata ( spot baldness)

9. Clinical features Round , sharply margined hair loss suddenly occurs. Hair regrows spontaneously in several months Rapid and complete loss of hair in one or several patches. Size – Patches of 1-5 cm in diameter . Associated disease 1.Atopic dermatitis. 2.Autoimmune disease – * SLE * Thyroiditis. *Myasthenia gravis. * Vitiligo . 3.Lichen planus . 4.Down syndrome . Alopecia areata ( spot baldness)

10. Diagnosis AA is usually diagnosed based on clinical features The hairs are characteristically thin and atrophic at the end of the hair root, giving them the appearance of exclamation marks (“ exclamation-point hair ”). Differential diagnosis Tinea capitis . Trichotilomania . Congenital triangular alopecia. .Alopecia neoplastica . . Alopecia areata ( spot baldness)

11. Management  Spontaneous recovery is extremely common for patchy alopecia areata . Psychological support . in severe cases give topical: Corticosteroid PUVA therapy Steroids and immunosuppressant are administered orally in alopecia totals or universals. Alopecia areata ( spot baldness)

12. Androgenic alopecia Definition : It is a very common, potentially reversible scalp hair loss that generally spares parietal and occipital areas (Hippocratic wreath) of the scalp. dihydrotestesterone ) Epidemiology Androgenetic alopecia is a very common disorder, affecting at least 50% of men by the age of 50. Female androgenic alopecia has become a growing problem affects around 30 million women in the  United States . The hairline recedes to form an M shape (with vellus hair at the frontal region of the head) or an O shape.

13. Etiopathogenesis : Exact mechanism is still unknown. Hereditary (Probably autosomal dominant) & Androgen ( specifically Etiology: Genetic Predisposition, Androgen excess, Ovarian cause- Polycystic ovarian syndrome , Other ovarian tumor , Unilateral benign microadenoma . Leydig cell tumor Hilar cell tumor. Androgenic alopecia

14. Adrenal cause - Congenital adrenal hyperplasia ( androgenital syndrome ) due to deficiency of – 21 hydroxylase (most common) 11- β hygroxylase . 3- β hydroxysteroid dehydrogenase . - Tumor Adrenal adenoma Carcinoma . Androgenic alopecia

15. CLINICAL FEATURE Hair loss starts any time after puberty “Whisker hairs” – first sign of impending male pattern alopecia, appear at the temple. “Professor’s angle” – anterior hair line recedes backward on each side. Eventually entire top of the scalp become devoid of hair . Christmas tree pattern”- diffuse and progressive reduction of density and diameter of hairs in the mid scalp. Maintenance of frontal hair lines with only slight recession. Androgenic alopecia

16. TREATMENT Topical Minoxidil (2% & 5%) -non specific hair growth promoter affecting anagen induction. Systemic Finesteride (1mg daily ). In women – spironolactone ( >100 mg daily ). Flutamide (250-500 mg bid or tid ). Cyproterone actate . Surgical treatment- Micrograft & minigraft from non-androgen dependent site (occiput). Androgenic alopecia

17. DEFINATION A neurotic practice of plucking or breaking hair from scalp or eyelash resulting usually localized or widespread areas of alopecia contains hairs of varying length. Mostly girls under age of 10 years. Disturbed mother- child relationship. Trichtillomania

18. Clinical features Patchy or full alopecia of the scalp (and sometimes eyebrows, eyelashes) Areas of alopecia often have bizarre shapes, irregular borders, and contain hairs of varying lengths Plucking associated with hair shaft fractures making hair ends feel rough Regrowth DDX alopecia areata , tinea capitis Trichtillomania

19. TREATMENT Behavioral modification therapy Selective serotonin reuptake inhibitor (SSRI) such as fluvoxamine , fluoxetine , paroxetine , sertraline , citalopram , etc. Topical minoxidil to help regrow hair Trichtillomania

20. Defination cicatricial alopecia , is the loss of hair which is accompanied with scarring.  It can be caused by a diverse group of rare disorders that destroy the hair follicle, replace it with scar tissue, and cause permanent hair loss . Scarring hair loss occurs in otherwise healthy men and women of all ages and is seen worldwide Cicatricial alopecia

21. Group 1: Lymphocytic Chronic cutaneous lupus erythematosus ( DLE) Lichen planopilaris (LPP) Classic LPP Frontal fi brosing alopecia Graham-Little syndrome Brocq’s alopecia Central centrifugal cicatricial alopecia (CCCA) Alopecia mucinosa Keratosis follicularis spinulosa decalvans Group 2: Neutrophilic Folliculitis Decalvans – used by different authors to mean different things; usually means the infl ammatory phase of CCCA ○ Dissecting cellulitis Group 3: Mixed Acne keloidalis Acne necrotica Erosive pustular dermatosis Group 4: Nonspecific Cicatricial (scarring) Alopecia

22. Cicatricial (scarring) Alopecia

23. Cicatricial (scarring) Alopecia

24. Clinical picture Symptoms Scalp tenderness Itching Burning sensation Cicatricial (scarring) Alopecia

25. Diagnosis Clinical Scalp Biopsy Management pioglitazone for diabetic aldoctone anthralin anti-dandruff shampoo Cicatricial (scarring) Alopecia

26.   This condition has been linked to mutations in the ribosomal GTPase  BMS1  gene Congenital alopecia

27. . Aplasia cutis congenita ACC  is a rare disorder characterized by congenital absence of skin Hypotrichosis congenita Normal hair is present at birth; however, alopecia gradually leads to thin, sparse hair Atrichia congenita It is autosomal recessive. Hair may be present at birth; however, it falls out between several months after birth and puberty, until no hair remains on the body. Involvement of the hairless ( hr ) gene has been identified as a cause in some cases of certain subtypes Congenital alopecia

28. Management conservative treatment surgical Congenital alopecia

29. Alopecia pityrodes Pityriasis capitis (“ dandruff”) occurs in combination with alopecia most frequently in men after puberty. grayish-white scaling occurs constantly on the scalp. The hair is thin and the natural gloss is not present. Itching and reddening of . Medical management Topical therapies for mild disease Best initial therapy: emollients and non-medical shampoos (zinc containing)  Low-potency topical steroids (e.g., hydrocortisone) Topical antifungals (e.g., ketoconazole or selenium sulfide) selenium or zinc pyrithione or tar shampoo Systemic therapies for severe or resistant disease oral antifungals (e.g., ketoconazole) oral steroids

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