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89 Cards in this Set
- Front
- Back
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what are the 3 functionally different section of hair follicle
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infundibulum
isthmus bulbar or inferior region |
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infundibulum
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upper 1/3rd of follicle
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isthmus
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middle 1/3rd of follicle
begins below subcutaneous duct to arrector pili |
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bulbar or inferior region
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lower 1/3rd of follicle
consists of hair bulb and matrix |
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does shaving change the growth rate of hair?
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no
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normal daily hair loss from scalp
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50-100 hairs/day
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scalp hair grows
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0.5 mm/day
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growth rate varies depending on...
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site of body, gender, age
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phases of scalp hair growth
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anagen
catagen telogen |
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anagen
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growth
3-5 years 90% of hairs |
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catagen
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transition
3 weeks 2 % of hairs |
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telogen
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resting
3 months 8% of hairs |
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hair color
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determined by two types of melanin: eumelanin and phaeomelanin
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eumelanin
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black and brown hair
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phaeomelanin
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blonde and auburn hair
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graying of hair
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due to lack of melanocyte function
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Premature graying without family history
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pernicious anemia, aging syndromes
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Poliosis
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vitiligo, alopecia areata, Waardenberg’s syndrome, Vogt-Koyanagi-Harada syndrome
a patchy absence or lessening of melanin in hair of the scalp, brows, or lashes, due to lack of pigment in the epidermis; it occurs in several hereditary syndromes but may be caused by inflammation, irradiation, or infection such as herpes zoster |
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Generalized lack of hair pigment
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albinism, Chediak-Hagashi syndrome (also white blood cell problems)
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Color changes
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nutritional deficiencies, phenylketonuria, chemical exposure
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abnormalities in hair pigmentation
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-Premature graying without family history
-poliosis -generalized lack of hair pigment -color changes |
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Pull Test
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-Gently grasp 30-40 hairs between thumb and forefinger and apply even traction pulling out from the scalp
-More than 2 hairs is a positive test |
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Hirsutism
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Androgen- dependent growth and development of hair in women in anatomic sites where such growth is considered secondary male characteristic
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Hypertrichosis
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Increased hair density or length beyond normal in any area of the body
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Etiology of Hypertrichosis
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Idiopathic
Disease associated Part of congenital syndrome Drugs (like cyclosporine and corticosteroids) |
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Etiology of Hirsutism
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Idiopathic
Hormone-secreting tumor Male hormone excess Medications |
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Electrolysis
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electrical current passed via probe into hair follicle, only permanent method of hair removal
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Hair removal lasers
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long term hair loss for use in select populations
you can only do this will darker hairs |
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treatment for increased hair growth
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-determine underlying cause and treat cause if possible
-electrolysis and hair removal lasers - shaving, depilatories, waxing and bleaching |
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History of Hair Loss
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-Hair coming out by roots vs. breaking off
-Time course loss -Thinning vs. increased fallen hairs -Medical history 6-12 months -Medications -Family history of hair loss -Hair care practices |
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Examination for Hair Loss
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-General appearance of patient
-Is the hair abnormality diffuse or localized? -Scarring or nonscarring? -Nails, lymph nodes, rest of skin -Pull test results -Hair shaft microscopy -Biopsy findings |
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Hair and Scalp Biopsy
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Usually 4mm punch biopsy is performed in area of concern
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Non-scarring
Common causes of hair loss |
Androgenetic
Telogen Effluvium Chronic telogen effluvium Alopecia Areata Traction Trichotillomania Chemical Damage |
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Scarring
Common causes of hair loss |
Lichenplanopilaris
Discoid lesions of lupus Psuedopalade Follicular Degeneration Misc.—sarcoid, neoplasm, infection, temporal arteritis |
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Which (non-scarring or scarring) hair loss has a better chance of regrowing hair?
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Non-scarring
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alopecia
(hair loss) |
-General Categories
-Coming out by roots versus breakage -Scarring verus non-scarring -Diffuse versus localized (or patchy) -Scalp only or involving other body sites |
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female pattern hair loss
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Diffuse frontal loss
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Androgenetic Alopecia
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Etiology remains unknown
Hereditary factors important but inheritance patterns unclear Hormones influence clinical disease (hair loss is not just passed down from men) |
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Red Flags Androgenetic Alopecia
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In women: rule out congenital adrenal hyperplasia, neoplasm, drug, polycystic ovary disease
-Patient younger than 20 -Patient with acute onset hair loss and clear signs of virilization |
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Treatment of Androgenetic Alopecia
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-Minoxidil 2% solution
-Minoxidil 5% solution -Oral 5-alpha reductase inhibitors -Oral Anti-Androgens -Hair Transplantation -Surgical flap procedures -Combinations of above |
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Alopecia Areata
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-Autoimmune process
-Common, especially in patients < age 30 -Can occur in localized or generalized manner -Non-Scarring form hair loss (THIS IS A PATCH) |
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Oral 5-alpha reductase inhibitors
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This was found by on an island where the men originally looked like women until puberty…these men never lost their hair or had prostate enlargement b/c of oral 5-alpha reductase inhibitors
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Alopecia areata tests
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-rarely biopsy
-lymphocytic peribulbar perivascular inflammation surrounding anagen follicles |
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Treatment of Alopecia Areata
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-Corticosteroids: topical, intralesional, short oral tapers, intramuscular
-Anthralin cream – keratolytic -Topical sensitizers -Psoralen and ultraviolet A light |
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Trichotillomania
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-A form of traction alopecia
-Characterized by a compulsion to pluck one’s hair -Often linked with other psychiatric diagnoses |
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common causes of Telogen Effluvium
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-Medications (going on and off oral contraceptives)
-Iron deficiency -Thyroid abnormalities -Post-partum alopecia -Weight loss (Atkin's Diet) -Protein calorie malnutrition -Physiologic stress (fever, systemic illness, surgery) |
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Telogen Effluvium
History and Clinical Exam |
-Diffuse non-scarring hair loss over scalp
-Can be acute or chronic -Usually begins 2-4 months after even/exposure (b/c that is how long telogen is) -If active, pull test is positive (>2/20 hairs between thumb and forefinger) |
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Drugs associated with Telogen Effluvium
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Androgens
Angiotensin Converting Enzyme inhibitors Beta-blockers Gold H2 blockers Oral contraceptives Minoxidil Retinoids Sulfasalazine Vitamin A |
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Minoxidil
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Rogaine
can initially cause hair loss because it is syncing up hair cycle growth |
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Telogen Effluvium Treatment
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-Often difficult to find a cause
-Stop any potential medications or recommend change to a different class -If applicable arrange nutrition counseling -Consider short term Minoxidil -Do not attribute hair loss to just “stress” -Lab evaluations as appropriate |
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Special Cases of Non-Scarring Alopecia
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-Anagen arrest with chemotherapeutic agents, radiation
-Tinea capitis (can cause scarring if very inflammatory) -Traction (can cause scarring if long-standing) |
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Anagen Effluvium
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-Seen rarely
-Hair in the growth phase shed instead of passing into the falling out phase |
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most common causes of Anagen Effluvium
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-- Heavy metals
-- Chemotherapeutic agents |
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Hair Breakage
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-Hair shaft abnormality
-Most commonly due to weathering from hair care practices |
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Hair Shaft Abnormalities
Categories |
-Structural defects with fragility of the hair shafts
-Structural defects without fragility of the hair shaft -Miscellaneous defects |
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Hair Shaft Abnormalities
Treatment |
treat the underlying condition, decrease manipulation, moisturizing shampoos and conditioners
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When you are on chemo, why don't you lose all your hair?
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because not all of the hair is in a growth phase
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Weathering of Hair Shafts
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-Common occurrence from over-processing from chemicals, heat damage
-Clinical exam: Brittle broken hairs of different lengths -Usually non-scarring |
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Uncombable Hair Syndrome
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spun glass looking hair
treat it like it is african american hair...using AA hair products |
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Scarring Forms of Alopecia
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Inflammatory scalp disease can cause scarring alopecia: dissecting cellulitis, acne keloidalis
Lupus erythematosus Neoplasms Trauma |
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Alopecia Universalis
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-Rare, recessively inherited form of alopecia universalis in Pakistani kindred
-Linkage on chromosome 8 -Human homolog of murine gene, hairless, found -Hairless likely encodes a transcription factor protein -->Hairless is the name of the gene |
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Nails
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-Can be helpful in diagnosis of systemic disease or skin disease
-Often forgotten portion of the physical exam -Fungal infections extremely common especially in the elderly -Acute nail changes may signal severe disease |
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Why is hair important?
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Important psychosocial role
- Defines personality - Can define attractiveness to opposite sex - Can define success and health |
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At level of the isthmus, layers from outermost to innermost layer
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-Surrounding connective tissue
-Outer root sheath -Inner root sheath --Henley’s layer, Huxley’s layer -Shaft --Cuticle, Cortex, +/- Medulla |
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What are tell tale signs of traction alopecia
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excoriations by hair follicles
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trichorrhexis
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A condition in which the hairs tend to readily break or split
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trichoschisis
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The presence of broken or split hairs
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Trichorrhexis Invaginata
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hair with regularly spaced nodules along the shaft caused by intermittent fractures with invagination of the distal hair into the proximal portion, with intervening lengths of normal hair, giving the appearance of bamboo; seen in Netherton syndrome; autosomal recessive trait
also called Bamboo Hair |
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nail matrix
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from where the nail grows
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lunula
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the white semi-circle at the base of nail
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proximal nail fold
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skin at base of nail
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lateral nail fold
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skin on sides of nail
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eponychium
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nail fold
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pitting of nails -- Psoriasis
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superficial lifting up
onycholysis pitting |
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onycholysis
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Loosening of the nails, beginning at the free border, and usually incomplete
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lovibond's angle
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the angle made at the meeting of the proximal nail fold and the nail plate when viewed from the radial aspect; normally less than 180 degrees, but greater in clubbing of the fingers
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clubbing
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seen in pt's with severe lung dz
(like CA or COPD) lovibond's angle >180 |
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Acute Bacterial Paronychia
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bacteria in the nail folds
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Chronic Paronychia
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this is not red
abnormal nail fold...appears whitish |
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photo-onycholysis
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when medications + sun = nail discoloration
caused by tricyclics |
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onychomychosis
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Thickening and subungal debris are common for tinea infection of the nail
Very common fungus infections of the nails, causing thickening, roughness, and splitting, often caused by Trichophyton rubrum or T. mentagrophytes, Candida, and occasionally molds |
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Terry's Nails
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-¾ of tha nails are white
-This is commonly associated with liver disease |
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half and half nails
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-½ white (proximal half is white)
-Is common with renal disease |
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beau's lines
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transverse grooves on the fingernails following severe febrile disease, malnutrition, trauma, myocardial infarction, or other disorders
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Splinter Hemmorhages are a sign of...
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bacterial endocarditis
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Herpatic whitlow
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herpes infection passed from mouth to wound by kissing a booboo
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periungual telangiectasias
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rheumatolic dz
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periungual
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surrounding a nail
involving the nail folds |
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Hutchinson's Sign
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-Pigment goes off the nail onto the skin.
-Pigment is only on one half (a side) of nail -This is a sign of melanoma |
