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36 Cards in this Set
- Front
- Back
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What are the 3 stages of the hair cycle, what happens in each one and how long is each one?
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Anagen - growth - 2-6years - determines how long someone's hair can grow
Catagen - growth slowing - 3 weeks Telogen - growth stops and follicle falls out - ALWAYS 3 months |
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What phase of the hair cycle are most scalp hairs in?
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Anagen
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Why are telogen hairs easier to pull out than anagen hairs?
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Because they don't have a root sheath anymore
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How can you tell the difference between scarring and non-scarring alopecia on physical exam?
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In scarring you can still see follicular openings whereas in scarring you cannot
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What are examples of non-scarring alopecia? (6)
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Androgenetic alopecia
Alopecia areata Telogen effluvium Traction alopecia Trichotilomania Tinea capitis |
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What are examples of primary scarring alopecias? (7)
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Lichen planopilaris
Frontal fibrosing Discoid lupus CCCA Pseudopelade Folliculitis decalvans Dissecting cellulitis |
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What is the clinical significance of having non-scarring alopecia vs. scarring?
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Non-scarring may not be permanent and can therefore be treated whereas scarring is permanent
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What happens to the hairs on the head in androgenetic alopecia?
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Terminal hairs are replaced by vellus-like hairs (thin)
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Where do women lose hair in androgenetic alopecia? Men?
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Vertex, usually spares frontal scalp
Vertex and temples |
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How do you treat androgenetic alopecia in women? Men?
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General = cream, pills, surgery
Women: 2-5% minoxidil, androgen blocking meds if elevated androgens, hair transplantation, hairpieces Men: 5% minoxidil, oral finasteride (inhibits conversion of testosterone to DHT), hair transplantation |
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Define alopecia areata, alopecia totalis and alopecia universalis
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Alopecia areata = Loss of some scalp hair +/- body hair
Alopecia totalis = Loss of all scalp hair Alopecia universalis = Loss of all scalp and body hair |
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What is ophiasis patter of alopecia areata?
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Hair loss from posterior scalp, difficult to treat
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What causes androgenic alopecia?
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Androgens
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What causes alopecia areata/totalis/universalis?
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Autoimmune attack of the hair bulb while sparing the stem cells which messes up hair cycling
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What are the clinical features of Alopecia Areata?
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No symptoms
Associated with atopy, thyroid problem, vitiligo, etc. Nail pitting Any hair bearing area can have hair loss |
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What tests would you order to workup alopecia areata?
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CBC, TSH, ferratin, B12
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How do you treat alopecia areata?
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Spontaneous reversal in >50%
<50% loss: topical and intralesional steroids, minoxidil >50% loss: immunotherapy with topical DPCP or squaric acid dibutyl ester Refractory: systemic steroids/immunosuppressants |
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What is telogen effluvieum more commonly known as?
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Hair shedding episode
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What is the cause of telogen effluvium?
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Triggers shifts hair follicles into telogen phase. These include:
S - Stress and scalp disease E - Endocrine - hypothyroid, post-partum N - Nutritional - diet, iron deficiency D - Drugs - acitretin, heparin, lithium, interferon, terbinafine, beta blockers, valproic acid, SSRI |
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What is the "pull test" and which disorder is it testing for?
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gently pull 50 hairs and if 5 or more hairs come out it is positive
Tests for telogen effluvium |
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What labs do you order for telogen effluvium?
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CBC, TSH, Ferritin
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How do you treat telogen effluvium?
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Stop trigger and it will resolve in about 6 months
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What are two classes of cicatricial (scarring) alopecia and what causes them?
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Primary - inflammatory attack that is directed at the hair follicle
Secondary - inflammation around hair follicle that kills it as a bystander |
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Why do scarring alopecias lead to permanent hair loss?
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Inflammatory infiltrates attack the isthmus and infundibulum which destroys stem-cells
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How are primary cicatricial alopecias classified?
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By which inflammatory cell type is predominant on biopsy
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Which primary cicatricial alopecias are lymphocyte associated?
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Lichen planopilaris
Frontal fibrosing alopecia Chronic cutaneous lupus Classic pseudopelade of Brocq Central centrifugal cicatricial alopecia |
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What primary cicatricial alopecias are neutrophil-associated?
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Folliculitis decalvans
Dissecting cellulitis |
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What is the most common scarring alopecia?
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Lichen planopilaris
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What causes lichen planopilaris?
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Autoimmune attack of upper hair follicle by lymphocytes
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What is the clinical presentation of lichen planopilaris?
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Itching, burning, pain/tenderness, continual hair loss
Perifollicular erythema, scale and loss of openings May have lichen planus on oral mucosa, nails, skin, genitals |
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How do you treat lichen planopilaris?
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Topical steroids or steroid injections
Systemic medications to slow disease (doxycycline, hydroxychloroquine, isotretinoin, mycophenolate mofetil, cyclosporine, methotrexate) Hair transplantation once disease quiescent |
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What is the most common scarring alopecia in black women?
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Central centrifugal cicatricial alopecia
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Which scarring alopecia looks like "foot prints in the snow"?
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Pseudopelade
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What type of immune cells are most abundant in folliculitis decalvans?
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Neutrophils
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What are clinical features of folliculitis decalvans?
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Pustules, crusting and tufting of hair follicles
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What is the "follicular occlusion tetrad"?
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Dissecting cellulitis
Acne conglobata Hidradenitis suppurativa Pilonidal cysts |
