Alopecia

(Part 2)
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Last Time on BoardsMD…

Alopecia Tinea capitis Tinea capitis (Black

areata (Kerion) Dot)

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 Alopecia (Part 2)

Telogen Androgenetic Traction Trichotillomani

effluvium Alopecia Alopecia a

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 Telogen Effluvium
• Presentation: Acute, diffuse, non-inflammatory hair loss
• Triggers:
• Pregnancy
• Surgery
• Stressors
• Menstrual Bleeding

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 Telogen Effluvium
• Pathophysiology: Loss of telogen hairs at their roots => Shedding

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Fevan

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Telogen Effluvium

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 Telogen Effluvium
• Dx: Exam => Normal scalp and hair density
• Positive hair pull test
• Labs: CBC, TSH, T4, Vitamin D, RPR, Ferritin
Hair with Visible Bulb

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 Telogen Effluvium
• Mgmt: Education and Reassurance
• Treat underlying cause
• +/- Minoxidil

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 Androgenetic Alopecia
• Presentation: Middle-aged male
• “Crown balding” + “Receding hairline”

• Pathophysiology: 5-Dihydrotestosterone (5-DHT)

• Genetic

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 Androgenetic Alopecia

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Androgenetic Alopecia

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Ludwig Scale

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 Androgenetic Alopecia
• Dx: Clinical

• Mgmt: Topical Minoxidil, Oral Finasteride

• Hair transplant surgery

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 Traction Alopecia
• Presentation: Reduced hair length and density
• Frontal and temporal scalp
• Triggers:
• Braids
• Hair extensions
• Ponytails
• Locks
• Chemical relaxers

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 Traction Alopecia
• Pathophysiology: Chronic traction
• Inflammation => Scarring

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Show

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Traction Alopecia

Fringe Sign
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 Traction Alopecia
• Dx: Exam => “Fringe sign”

Fringe Sign

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 Traction Alopecia
• Mgmt: Education
• Early => D/C Traction, Minoxidil
• Late => Irreversible

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 Trichotillomania
• Presentation: Irregular patches of hair loss w/ var ying lengths
• More common in women

• Pathophysiology: Serotonergic
• Commonly have OCD, MDD

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 Trichotillomania
• Dx: Recurrent hair-pulling despite attempt to stop
• Causes distress or impairment
• NOT due to Body Dysmorphic Disorder
• Negative “hair-pull test” (vs. Androgenetic alopecia, Telogen effluvium, Alopecia
areata)

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 Trichotillomania
• Mgmt: CBT (Habit Reversal Training)
• SSRIs
• Clomipramine
• Atypical antipsychotics
• N-acetylcysteine

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 Other Causes of Alopecia (USMLE)
• 2˚ syphilis
• PCOS 2˚ syphilis => “Moth-eaten”
• Discoid lupus erythematosus
• Scarring alopecias
• Thyroid disease
• Zinc deficiency
• Methotrexate

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High-Yield Summary
Telogen Androgenetic
effluvium alopecia
• Pres: Acute-onset • Pres: Middle-aged
• Stressful event • Crown-balding
• Receding hairline

• Path: Telogen • Path: 5-DHT

• Dx: Normal scalp • Dx: Clinical

• Positive hair-pull
• +/- Ferritin, TSH • Mgmt: Topical Minoxidil
• Oral Finasteride

• Mgmt: Education

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High-Yield Summary
Traction Trichotillomani
Alopecia a
• Pres: Frontal and temporal • Pres: Female
loss • Irregular patches
• Braids, Locks, Ponytails • Varying lengths

• Path: Traction => Scarring • Path: OCD

• Dx: “Fringe sign” • Dx: Negative hair-

pull

• Mgmt: Education
• Mgmt: CBT

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 High-Yield Summary

Telogen Androgenetic Traction Trichotillomani

effluvium Alopecia Alopecia a

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