Hair Loss or Alopecia

HAIR LOSS : HAIR LOSS DR. SUDHEENDRA U Dermatologist & Venereologist

HAIR LOSS : HAIR LOSS Hair loss is a commonly encountered problem Loss of hair from any hair bearing part of the body is termed medically as alopecia Before going into details of hair loss its need to understand something about hair structure First, hair grow in a cycle with a growing phase, involuting phase & a resting phase So we can expect some amount of hair to fall off daily as a routine part of the hair cycle, this number varies from about 75 to 100 per day

CAUSES : CAUSES Causes of Hair loss are divided into 2 types Non-Scarring – here the hair follicles are present so re-growth can be expected with proper treatment or spontaneously Scarring – here the follicles are destroyed, re-growth of hair is not possible

Non-Scarring alopecia : Non-Scarring alopecia There are several causes of non-scarring alopecia, they include Male pattern or Female pattern baldness Alopecia areata Telogen Effluvium Anagen Effluvium Drug induced alopecia

Male pattern or Female pattern baldness : Male pattern or Female pattern baldness These are the patterned form of hair loss that occur gradually as the person ages Its due to genetically determined predisposition of some of the hair follicles to undergo miniaturization with exposure to male hormones The pattern of hair loss is different in males and females It can be managed with some of the lotions like Minoxidil used at 2% and 5% In males, oral medications like finasteride can be used The response to treatment is gradual and its unpredictable. If results are obtained than the treatment needs to be continued to maintain the results Surgical measures like scalp reduction, hair transplantation, direct hair implantation etc offer permanent solution to the problem Other measures like hair weaving, wigs can also be used

Alopecia areata : Alopecia areata Its an autoimmune disorder where the body starts producing antibodies against hair follicle causing patches of hair loss The cause is not known, but it is associated with some other autoimmune problems like thyroid disorders, pernicious anemia, vitiligo etc. It can be triggered by stress. In children it may also be associated with atopic dermatitis Alopecia areata preferentially effects the pigmented hair without involving the depigmented hairs Commonly seen in children as round to oval bald patches with the edges of lesion showing hair that are thin towards base and thicker towards end – EXCLAMATION MARK HAIR

Alopecia areata : Alopecia areata Severe forms of the condition include Alopecia totalis – whole scalp hair is lost with eye brows and eye lashes Alopecia universalis – whole body hair are lost Ophiasis – a wavy serpentine hair loss on the margins of the posterior scalp Sisaihpo – The reverse of ophiasis, wavy serpentine hair loss on margins from the anterior scalp In most of the cases re-growth is seen spontaneously. Treatment options include Intralesional steroid injections, Contact sensitization with (Diphenyl Cyclopropene) DPCP or (Squaric acid dibutyl ester) SADBE, Minoxidil Topical anthralin PUVA therapy Tacrolimus etc

Telogen effluvium : Telogen effluvium It is the bout of hair loss that occurs due to sudden precipitation of hair into telogen hair which fall in 2-3 monthThe causes for acute telogen effluvium includes High fevers – Typhoid, malaria etc Sever stress – Accidents, surgery etc Pregnancy Causes of Chronic telogen effluvium includes Iron deficiency anemia Malnutrition or malabsoprtion Endocrinal disorders like hypothyroidism, hyperthyroidism etc It presents as bout of hair loss about 2-3 months of the severe illness In chronic cases the loss of telogen hair continues for more than 6 months In acute cases it stabilises in few months with re-growth of hair in about 6 months No treatment is required other than supportive measures in acute cases In chronic cases the underlying cause must be corrected

Drug induced alopecia : Drug induced alopecia There are several drugs that can cause hair loss Most common is the anti-chemotherapeutic drugs Others include heparin, anti-thyroid medications etc

Trichotillomania : Trichotillomania It’s a Obsessive disorder where the patient has an uncontrollable sense to pull out his/her own hair, with relief following the pulling out of hair More commonly seen in young females The classical picture is that of patches of hair loss with broken ends of hair of varying length present in a twisted form Most patients deny the habit of pulling out their hairs In some of the patients they chew and eat the pulled out hair resulting in formation of trichobezoar in the stomach The treatment includes counselling, psychiatric consultation, behavioural therapy

Traction alopecia : Traction alopecia Some of the hair styling measures that exert considerable degree of traction on the hair can result in alopecia Here the hair loss is seen from the margins of scalp where the hair are subjected to significant traction It resolves with correction of the hair styling measures In late stages it may become scarring type

Scarring alopecia : Scarring alopecia There are several causes of scarring alopecia, few important ones among them are Inflammatory condition of skin – Lichen planopilaris, discoid lupus erythematosus Inflammatory condition of unknown causes – folliculitis decalvans, dissecting cellulitis of scalp Severe infections like – recurrent furuncles, kerion, favus etc Traumatic – Radiodermatitis, Mechanical trauma, Postoperative, Burns, Accidental alopecia, Dermatitis artefacta, Hot comb alopecia Sclerosing disorder – Morphoea, Scleroderma, Lichen sclerosus, Sclermodermoid porphyria cutanea tarda, Chronic GVHD

Scarring alopecia : Scarring alopecia Follicular inflammatory disorders like keratosis pilaris atrophicans Pseudopelade of Brocq – an end stage manifestation that can happen because of other condition causing scarring alopecia Granulomatous – Sarcoidosis, Necorbiosis lipoidica, Infectious granulomas Developmental defects and hereditary disorders - Aplasia cutis, Facial hemiatrophy, Hair follicle hamartomas, Incontinentia pigmenti, Focal dermal hypoplasia of Goltz, Porokeratosis of Mibelli Neoplastic Benign – Cylindroma, other adnexal tumours Malignant Primary – Basal cell ca., Squamous cell ca., CTCL Secondary – Renal, breast, Lung, gastrointestinal, Lymphoma, Leukemia

Thank You : Thank You For any Questions Contact Dr.Sudheendra U sudhiudb@gmail.com Disclaimer: The aim of the presentation is to provide just basic knowledge about various causes of alopecia, it is neither complete nor comprehensive and should not form a basis for treatment of hair loss