Alopecia

Defination
Alopecia(Gk..Alopekia=baldness)…….Diffuse(global
hair loss
Classification
-non scaring
-scaring
-Biphasic
ANDROGENETIC ALOPECIA

 The commonest type of hair loss

 Characterized by a progressive & patterned scalp hair loss
 A genetically determined, androgen-dependent disorder
EPIDEMIOLOGY
Caucasians:
 30% of men by the age of 30
 40% by 40
 50% by 50
 50% of women by the age of 60
 Caucasians(4x)>blacks>Asians
 Common in both sexes, but MPHL>FPHL
Age of onset
 MPHL - Any time after puberty; often fully expressed in the 4 th decade
 FPHL - Later compared to men
 During/after puberty, peri-menopausal p’d & menopause.
 40% …..in the 6th decade
Etiopathogenesis

• Genetic predisposition & sufficient circulating androgens

• Altered hair cycle dynamics & follicular miniaturization

In both, MPHL & FPHL
• Progressive decline in the duration of anagen
• An increase in the duration of telogen
• Miniaturization of scalp hair follicles
CLINICAL FEATURES

MPHL
 Progression in an orderly manner, as documented by Hamilton &
Norwood
 The posterior & lateral scalp margins are relatively spared, and only
affected in the most advanced cases and with old age
 Men may show a more female pattern
MPHL- Hamilton-Norwood classification
Hamilton classification
 Type I - Prepubertal scalp with terminal hair growth on the forehead & all
over the scalp
 Type II & III - Gradual frontal recession of the hairline (mostly M-shaped)
 Type IV, V & VI - Additional gradual thinning in the vertex area
 Type VII & VIII - Confluence of the balding areas & leave hair only around
the back & the sides of the head
FPHL
 The most common pattern of FPHL
 A diffuse central thinning of the crown with preservation of the frontal
hairline
 Ludwig grade I - Minimal widening of the part width
 Ludwig grade II - Moderate thinning
 Ludwig grade III - Significant thinning & widening of the part width
‘
Treatment
MPHL
 TOPICAL MINOXIDIL
 FINASTERIDE
 DUTASTERIDE
FPHL
 MINOXIDIL
 ANTIANDROGENS
 17a- AND 17b-ESTRADIOL
Alopecia Areata

 chronic inflammatory disease that involves the hair follicle and

sometimes the nails

 0.1–0.2% with lifetime risk of 1.7%

 both sexes equally affected

 Tcell mediated autoimmune mechanism occurring in genetically

predisposed individuals

 Environmental factors may be responsible for triggering the

disease
Clinical feature
 an acute onset oval or round, well-circumscribed
bald patches with a smooth surface
Classification
 localized patch
 alopecia totalis
 alopecia universalis
 other rare variant are ophiasis and sisapho
 Associated disease
 cataracts, thyroid disease, vitiligo, atopic dermatitis
 psoriasis, and immunodysregulation
polyendocrinopathy enteropathy X-linked syndrome
(IPEX), Cronkhite–Canada, and Down syndromes
•
 Treatment
AA may improve on its own. No cure or preventive
treatment for AA has been established
corticosteroids have been the most popular treatment.
Other option is Minoxidi, Anthralin and etc.
CICATRICIAL ALOPECIA
FOLLICULITIS DECALVANS

 11% of all primary cicatricial alopecia cases

 Young & middle-aged adults
 M>F
 More frequently, in African Americans than Caucasians
Etiopathogenesis
 Not fully understood, but suspected possible pathogenetic
factor
 S.aures
 Hypersensetive rxn to super antigen
 Defective CMI
 Genetic factor
CLINICAL FEATURES

 Itching, pain &/or burning sensations

 Vertex & occipital areas,
 Initial lesion-an erythematous follicular papule
Hallmark
 Scarred erythematous alopecic patches
 Follicular pustules
 Tufted folliculitis
 Multiple hairs (5–15) emerge from one single,
dilated follicular orifice
 Yellow-gray scales & erythema can be present
(esp.around the follicles).
 Follicular hyperkeratosis
Medical Rx
 Oral antibiotics
 Topical antibiotics
 Antiseptics
 Topical & intrealesional steroids
 Systemic corticosteroids
 ACNE KELOIDALIS NUCHAE

• AAn inflammatory cicatricial alopecia affecting the nuchal

hairline
• Almost exclusively- black/african american men age, 14-25
• Black females & Caucasians may also be affected

ETIOPATHOGENESIS
• Unclear, but thought to be due to:
• Chronic irritation from coarse, curly hairs
• Frequent hair cut
CLINICAL FEATURES
• Pruritus & burning
• Nape of the neck & occipital scalp
Vertex & parietal involvement could occur.
• Early ds-Follicular papules & pustules
• Papules coalesce
• Nodules or broad keloidal plaques
• Tufting,
• Abscesses, sinuses, foul-smelling
discharge =not uncommon.
• Large sclerotic tumors
Treatment
 intralesional steroid
Potent topical steroid
Topical antibiotics
Cryotherapy
Systemic antibiotic
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