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Questions and Answers

What is androgenetic alopecia, and how does it typically present in men over 50?

Androgenetic alopecia is a hereditary form of hair loss characterized by thinning of hair on the crown and temples, affecting about half of men over 50.

Define hirsutism and describe its impact on women.

Hirsutism is excessive male-pattern hair growth in women, impacting approximately 8% of adult women, often leading to psychological distress.

What is the primary difference between scarring and non-scarring alopecia?

Scarring alopecia involves the destruction of hair follicles, leading to permanent hair loss, while non-scarring alopecia can often be reversed.

Identify and briefly explain one type of non-scarring localized hair loss.

Traction alopecia is a type of non-scarring hair loss caused by tension on the hair, often from styles like tight ponytails. Signup and view all the answers

What role does the anagen phase play in hair growth, and how long can it last?

The anagen phase is the active growth phase of hair, lasting typically 4-6 years, with hair growing at about 0.3 mm per day. Signup and view all the answers

Explain how hypertrichosis differs from hirsutism.

Hypertrichosis is a condition characterized by excessive hair growth in areas not typically affected by androgen, unlike hirsutism, which is androgen-dependent. Signup and view all the answers

Discuss the significance of trichotillomania in the context of hair disorders.

Trichotillomania is a psychological condition where individuals compulsively pull out their own hair, leading to localized hair loss. Signup and view all the answers

Name a common diagnostic approach for assessing alopecia type.

A common approach is to perform a scalp examination and possibly a scalp biopsy to determine the type of alopecia. Signup and view all the answers

What is the primary hormonal contributor to the miniaturization of hair follicles in androgenetic alopecia?

Dihydrotestosterone (DHT) is the primary repressor of hair growth. Signup and view all the answers

Describe the difference in the pattern of hair loss between men and women with androgenetic alopecia.

Men experience recession of the frontal hairline and thinning at the vertex, while women have more diffuse thinning with a characteristic retention of the frontal hairline. Signup and view all the answers

Which treatment options are recommended for male patients suffering from androgenetic alopecia?

Finastride and Minoxidil (5% concentration) are recommended for male patients. Signup and view all the answers

How does Minoxidil function in treating hair loss, and what are its recommended concentrations for men and women?

Minoxidil increases cutaneous blood flow to hair follicles, with 5% for men and 2% for women recommended. Signup and view all the answers

What constitutes hirsutism in females, and what is its primary cause?

Hirsutism is defined as the growth of terminal hair in male-pattern areas in females, primarily caused by increased androgenic activity. Signup and view all the answers

List two possible adrenal causes for hirsutism.

Adrenal gland tumors and Cushing's syndrome are two potential adrenal causes of hirsutism. Signup and view all the answers

What are the available surgical treatments for androgenetic alopecia?

Hair transplantation and scalp reduction are the surgical treatment options for androgenetic alopecia. Signup and view all the answers

Explain why oral zinc sulphate might be used in the management of hair disorders.

Oral zinc sulphate acts as an immunomodulator which may help in the treatment of certain hair disorders. Signup and view all the answers

What is the primary distinction between telogen effluvium and anagen effluvium in terms of hair loss onset?

Telogen effluvium has a delayed onset of hair loss due to early entry into the telogen phase, while anagen effluvium results in abrupt hair loss from the growing anagen phase. Signup and view all the answers

List two significant prognostic indicators that suggest a bad outcome in patients with alopecia areata.

Rapid progression of hair loss and loss of eyebrows and eyelashes. Signup and view all the answers

What role do immunological factors play in the etiology of alopecia areata?

Immunological factors contribute to the autoimmune aspects that lead to hair follicle attack and resultant hair loss. Signup and view all the answers

Describe the impact of psychological stress on hair loss, particularly in the context of telogen effluvium.

Psychological stress can initiate telogen effluvium by causing an early transition of hair follicles from anagen to telogen phase, leading to delayed hair shedding. Signup and view all the answers

Identify one key treatment option for alopecia areata and explain its mechanism.

Topical or intralesional steroids are used to reduce inflammation and suppress the immune response targeting hair follicles. Signup and view all the answers

Explain the term 'ophiasis' in the context of alopecia areata.

Ophiasis refers to a pattern of hair loss where hair is lost from the back and sides of the scalp, often indicating a poor prognosis. Signup and view all the answers

What are common clinical manifestations of androgenetic alopecia in both genders?

In men, it typically presents as a receding hairline and thinning crown, while in women, it usually manifests as diffuse thinning over the crown. Signup and view all the answers

What is hypertrichosis and how does it differ from hirsutism?

Hypertrichosis is excessive hair growth in areas not typically associated with male-pattern hair, whereas hirsutism refers to excess hair growth in women in male-pattern areas. Signup and view all the answers

Study Notes

Hair Disorders

A broad category encompassing hair loss or thinning, excessive hair growth, and hair shaft abnormalities.
Alopecia: Hair loss or thinning. Two main types: scarring (irreversible) and nonscarring (potentially reversible).
Male pattern baldness (androgenic alopecia): The most common type of hair disorder, affecting half of men over 50 years old.
Hirsutism: Excessive male-pattern hair growth in women, affecting 8% of adult women.

Alopecia

Diffuse: Hair loss that spreads evenly across the scalp.
Patchy (Localized): Hair loss in specific patches on the scalp.

Phases of Hair Growth

Anagen: Growth phase, lasting 4-6 years. Hair grows 0.3 mm/day or 1 cm/month.
Catagen: Follicular regression phase. Hair detaches from blood vessels. Lasts 2 weeks.
Telogen: Resting phase. Hair remains dormant for 3-4 months.
Exogen: Extension of the telogen phase where hair shedding occurs.

Localized (Patchy) Hair Loss

Non-Scarring:
- Neonatal hair loss: Hair loss in newborns.
- Early treated pyogenic or fungal infections: Hair loss following successful treatment of infections.
- Traumatic alopecia: Hair loss caused by physical trauma.
  - Neonatal frictional alopecia: Hair loss due to friction from rubbing or scratching.
  - Trichotillomania: Habitual hair pulling.
  - Traction alopecia: Hair loss from tight hairstyles or pulling.
  - Alopecia areata and lichen simplex: Hair loss associated with autoimmune diseases.
- Psoralen and ultraviolet light "PUVA": A phototherapy treatment used for skin conditions, potentially causing hair loss.
- Topical Minoxidil, Anthralene (Dithranol): Topical treatments for alopecia, potentially causing hair loss.
- Immunomodulators: Treatments that modify the immune system, potentially causing hair loss.
  - BCG vaccination: A vaccination given to prevent tuberculosis, potentially causing hair loss.
  - Oral zinc sulfate, ionosiplex: Supplements that boost the immune system, potentially causing hair loss.
- Psychotherapy: For anxiety and stress, which can exacerbate hair loss.

Androgenetic Alopecia (Common Baldness)

Etiology:
- Hair follicles undergo miniaturization and shorter anagen phase.Hair shafts become shorter and thinner.
- Dihydrotestosterone (DHT) is believed to be a primary repressor of hair growth.
- Rate of progression and pattern are genetically determined.

Androgenetic Alopecia Signs/Symptoms - Men

Insidious onset, typically after puberty.
Progression can fluctuate.
Hair loss occurs at the top of the head (vertex), frontal hairline, and occipital regions.
Hair recession at the frontal hairline is often the first sign.

Androgenetic Alopecia Signs/Symptoms - Women

More diffuse hair thinning than men.
Frontal hairline is usually retained.
Hair density remains relatively normal, but hair length does not grow.

Androgenetic Alopecia Treatment

Medical Treatment:
- Antiandrogens: Medications that block the effects of androgens (like testosterone) for women.
  - Cyproterone acetate, spironolactone, contraceptive pills.
- Finasteride: A medication used to treat male pattern baldness but can be used in post-menopausal women.
Minoxidil: A topical medication that can stimulate hair growth.
- 2% concentration recommended for women.
- 5% concentration recommended for men.
- Shows results within 2-4 months.
- Available in spray, dropper, rub-on form.
- Hair density can return to pretreatment levels after discontinuation.
- Finasteride can enhance its effectiveness.

Hirsutism (Excessive Hair Growth)

Etiology: Growth of terminal hair in females in androgen-dependent areas due to elevated androgen levels.
Pathophysiology:
- 50-70% of circulating testosterone in normal women is derived from adrenal or ovarian precursors.
- Excess testosterone can result from a variety of conditions and medications.

Hirsutism Causes

Adrenal Causes: Conditions affecting the adrenal glands, which produce hormones.
Ovarian Causes: Conditions affecting the ovaries, which produce hormones.
Other Causes:
- Alopecia Areata: An autoimmune disorder that attacks hair follicles.
- Medications: Some medications can lead to hirsutism.

Scarring Alopecia (Irreversible Hair Loss)

Causes:
- Developmental defects & hereditary disorders: Genetic conditions affecting hair follicles.
- Physical/chemical agents: Burns, radiation, or chemical trauma.
- Infections:
  - Bacterial: Infections caused by bacteria.
  - Fungal: Infections caused by fungi.
  - Viral: Infections caused by viruses.
  - Protozoal: Infections caused by protozoa.
- Neoplasms: Tumors or growths.
- Miscellaneous:
  - Lupus erythematosus: An autoimmune disorder that attacks the body's tissues.
  - Lichen planus: An inflammatory skin condition.
  - Pseudopelade: A rare condition characterized by hair loss in patches.
  - Scleroderma/morphea: A skin condition that causes hardening of the skin.
  - Lichen planopilaris: An inflammatory condition affecting hair follicles.

Diffuse Hair Loss

Causes:
- Androgenetic alopecia (Common baldness)
- Congenital: Present from birth, such as ectodermal dysplasia.
- Alopecia areata (Diffuse form): An autoimmune disorder that attacks hair follicles.
- Telogen effluvium: Hair loss due to stress.
- Metabolic and endocrine disorders: Conditions affecting the body's metabolism or hormone production.
- Nutritional deficiencies: Lack of essential nutrients for hair growth.
- Drugs and chemicals: Medications and chemicals that can cause hair loss.
- Chronic illnesses: Long-term illnesses that can lead to hair loss.
- Chronic diffuse alopecia of unknown origin: Hair loss with no identifiable cause.
- Hair shaft abnormalities: Structural problems with hair shafts.

Telogen Effluvium vs Anagen Effluvium

Telogen effluvium: Hair loss triggered by stress that causes hair to prematurely enter the telogen phase, leading to shedding months later.
- Psychological stress: Examples: Bereavement, major life changes.
- Physiological stress: Examples: COVID-19, illness.
Anagen effluvium: Abrupt hair loss during the anagen (growing) phase, caused by events that disrupt follicle activity.
- Drugs: Examples: Chemotherapy, anticoagulants, antidepressants.
- Radiation Therapy: Radiation to the scalp.

Alopecia Areata

Alopecia Totalis: Complete hair loss on the scalp.
Alopecia Universalis: Complete hair loss on the entire body.
"Exclamation-mark" hair: A characteristic pattern of hair loss with exclamation point-shaped patches.
Pigmentary changes: Skin discoloration can accompany hair loss.

Alopecia Areata Nail Changes

Nail pitting (small indentations in the nails).
Dystrophy (abnormal nail growth).
Pigmentation (discoloration).

Alopecia Areata Etiology

Genetic factors: A family history of alopecia areata increases the risk.
Immunological factors: The immune system attacks hair follicles.
Psychological factors: Stress can trigger alopecia areata.
Significant association with atopic state and Down syndrome. Individuals with these conditions have a higher risk of alopecia areata.

Alopecia Areata Course and Prognosis

Bad prognostic signs in alopecia areata:
- Alopecia areata in atopic individuals.
- Rapid progression of hair loss.
- Loss of eyebrows and eyelashes.
- Severe nail changes (pitting, dystrophy, pigmentation).
- Ophiasis: Hair loss on the back and sides of the scalp.
- Hair loss in a reticular pattern (net-like).
- Alopecia totalis and universalis.
- Family history of atopy or alopecia areata.
- Early onset before puberty.

Alopecia Areata Treatment

Irritants: Topical applications that can irritate skin and stimulate hair growth.
- Phenol, salicylic acid, resorcinol, garlic, plant extracts.
Potent topical or intralesional steroids: Medications that suppress inflammation.
Chemical sensitizers: Substances that induce an allergic reaction to stimulate hair growth.
- Di-nitrochlorbenzene, squaric acid dibutylester.

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