DISORDER OF THE HAIR
Disorder of the hairTypes of hair :- Lanugo hair :- soft,fine,unmedullated hair that covers much of the foetus & usually shed before birth . Vellus hair :- fine,short,unmedullated cover much of the body surface , they replace the lanugo hair. Terminal hair :- long,coarse,medullated hairs ( scalp hair & pubic region . Their growth is often influenced by circulating androgen level .
Disorder of the hair
Hair loss (alopecia) :- Alopecia means hair loss , which can be localized or diffuse . It is also important to determine wether or not the hair follicle have been replaced by scar tissue in which regrowth can not occur (cicatricial alopecia) , or normal tissue (non –cicatricial alopecia) .Disorder of the hair
Differential diagnosis of hair loss :- A- non-scarring alopecia :- 1- diffuse hair loss. 2- focal hair loss . B- scarring alopecia .Disorder of the hair
A- Non-scarring alopecia :- 1- Diffuse hair loss :- Abnormality hair production (cong. Hypotrichosis or atrichia) . Hair breakage (hair shaft abnormality) . Abnormality of cycling (shedding) :- a- Telogen effluvium . b- Anagen effluvium . c- Alopecia areata .Disorder of the hair
A- Non-scarring alopecia :- 2- Focal hair loss :- Abnormality of hair production ( androgenetic alopecia ) . Hair breakage :- a - Trichotillomania . b - Traction alopecia . c - Tinea capitis . d - Primary or acquired hair shaft abnormality . 3. Abnormality of cycling :- a- alopecia areata. b - syphilis .B – Scarring hair loss :-Developmental defects ( e.g. epidermal nevi , aplacia cutis )Physical injuries :- mechanical trauma , burns , radio dermatitis .Fungal infection :- kerion , favus .Bacterial infection :- T.B. , syphilis , carbuncle , furuncle , folliculitis.Protozoal infection :- leishmaniasis.Viral infection :- herpes zoster , varicella.Tumors :- basal cell ca. , sequamous cell ca. , syringoma, metastatic tumor , lymphoma.Dermatosis of uncertain etiology :- lichen planus , lupus erythematosus , scleroderma , dermatomyositis , etc….9. Medicament:- high dose of busulfan
Disorder of the hair
Etiologies of telogen effluvium :- 1- endocrine :- Hypopituitrism . Hypo-hyperthyroidism. Peri or post-menapausal state. Hypoparathyroidism. Diabetes, poorly controlled. 2- Nutritional :- Caloric deprivation. 5. biotin deficiency . Protein deprivation. 6. iron deficiency . Essential fatty acid deficiency. Zinc deficiencyTelogen effluvium
3- Drugs :- Anticoagulants. Angiotensin-converting enzyme inhibitor. Antimitotic agents. Beta-blocker. Retinoids , vit. A excess. Oral contraceptive. Hydantoin , valproic acid. Carbimazole , thiouracil , iodide . lithiumTelogen effluvium
4- Physical stress :- Anemia. Systemic illness. Surgery. Blood donation. Crash dieting ( sudden sever reduction in diet ). Prolong difficult labour . 5- Psychological stress.Anagen effluvium
Radiotherapy. Cytotoxic agents especially alkalating agent. Thallium poisoning. Toxic exposure to colchicine. Mercury or boric acid intoxication. Sever protien malnutritionAlopecia Areata
One of the most important patterns of non-cicatricial alopecia. It affects about 2% of the patients seen in the out-patient clinics. Charac. By sudden rapid & complete loss of hair in one or more often several round oval patches usually on the scalp , beard , eye browse , eye lashes & rarely on other hairy areas of the body.Alopecia Areata
Etiology :-Unknown .Most evidence points toward its being an autoimmune disease (associated with several autoimmune disease as chronic lymphocytic thyroiditis “hashimoto`s thyroiditis” , pernicious anemia , addison`s disease , vitiligo & atopy ) .Modified by genetic factors (25% have family history of alopecia areata ) .Aggravated by emotional stress .
Alopecia Areata
Clinical features :- Oval patches of hair loss with normal appearing scalp & no scaling with easily plukable loose hairs at the periphery of enlarging one which may break off near the scalp (4mm) leaving short stump when they are pulled out a tapered attenuated bulb is seen as a result of atrophy of that portion (exclamation mark) . Patches may be single or multiple or even diffuse . Alopecia totalis (whole scalp is involved) . Alopecia universalis (all over the body) . Nail changes :- in the form of fine pitting , punctate leukonychia , or even dystrophy .Alopecia Alopecia
Course :- unpredictable , spontaneous remission with alopecia araeta is common , but less with totalis or universalis . Bad prognostic factors :- Onset before puberty . Associated with atopy or down's syndrome . Unusual wide spread alopecia (totalis or universalis) or ophiasis . Associated with autoimmune disease .Alopecia Areata
Differential diagnosis :- Tinea capitus . Lupus erythematosus . Lichen planus . Trichotillomania . Traction alopecia . Secondary syphilis (moth-eaten alopecia) .Alopecia Areata
Treatment :- reassurance , treatment can be divided into 4 main types :- non specific irritant e.g. dithranol & phenol . Immune inhibitors e.g. topical & intralesional steroid , PUVA , cyclosporine (topical cyclosporine 5-10%) Immune enhancer DNCB , squaric acid induce allergic contact dermatitis when applied to the area . Non specific immune modulator e.g. BCG , zinc sulphate . Unknown action e.g. minoxidil . Wigs should be encouraged to use in extensive disease .Traction Alopecia
Prolonged tension , created by certain hair styles , such as braids , or pony tails , hair rollers , & hot hair-straightening combs , may result in temporary or , rarely permanent hair loss in an area corresponding exactly to the stressed hair . The scalp may appear normal or may show evidence of inflammation or scarring .Trichotillomania
Trichotillomania :- is a compulsive habit that induces an individual to pluck hair repeatedly . female : male = 2 : 1 . Children : adult = 7 : 1 . The child develop the habit of twisting hair around the finger & pulling it . The act is only partially conscious . Emotional deprivation in the maternal relation ship is considered important in initiating the habit .Trichotillomania
Clinical feature :- hair is plucked more frequently from fronto parietal region resulting in an ill-defined patch on which the hair are cut & broken at various length from the scalp . Scalp is normal . Patient usually denies touching her or his hair . Eyelashes , eyebrows , & other hairy areas could be affected . Usually contra lateral side .