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Learning Hair and Scalp Conditions – Part One

Dr. Joseph English lectured on the various conditions that affect our patients’ hair and scalp at the SDPA 2014 Fall Conference in San Diego.

Dr. Joseph English lectured on the various conditions that affect our patients’ hair and scalp. The objectives of his talk were for attendees to learn scarring and non-scarring alopecias and to understand the evaluation and management of alopecia. Here we highlight some of the conditions Dr. English presented.

Telogen Effluvium is the increased shedding of Telogen hair, a response to a pathologic or normal physiologic change in health status. Starts 3 months after the stresser and last up to 12 months. Once you get it, you can always get it.

Etiology:?

  • Medical: Anemia, Thyroid disease, Malnutrition, Vitamin deficiency, Weight loss/gain, ?Start/stop medications
  • Psychological: Stress, Anxiety, Depression, OCD, ADHD

Lab Evaluation:?

  • CBC, Iron panel, Ferritin, TSH, T4, Thyroid antibodies, B12/folate, Zinc, ?Vitamin D

Treatment:?

  • ?Education
  • Eliminated any associated cause

Androgenic Alopecia is a genetically determined sensitivity of scalp hair follicles to miniaturize due to adult levels of androgens. Testosterone + 5 alpha reductase DHT.

Patterns:

  • Male
  • Female? – Puberty to 20-30’s, perimenopausal, menopausal, senile

Treatments:?

  • Rogaine, Finasteride, Dutasteride, 635nm light, Hair transplant
  • OCP + spironolactone (pre-menopausal women)

Note that it may be a skin sign of systemic disease:

  • Metabolic syndrome (men and women) – younger age of onset with ?severe disease
  • Prostate cancer seen with black men
  • Test for women for ovarian tumors, testosterone levels, adrenal abnormalities

Alopecia Areata is an organ specific autoimmune disease. Here, the CD8 + NK killer cells lose tolerance against the hair follicle. It does have familial tendencies.

Patterns:

  • Patch to 99%, totalis, universalis
  • Various loss patterns: snake, paw print, patchy

Treatment:?

  • IL – oral steroids, immunotherapy (sensitize the patient to it and note that it takes 12 months), methotrexate (works for 50-99% hairloss)

Skin sign of Systemic disease:?

  • Autoimmune thyroiditis
  • Diabetes
  • Pernicious anemia
  • Ask about secondary syphilis

Image: Gemma Bou




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