Alopecia Disease
Alopecia Disease
BASICS
DESCRIPTION
Absence of the hair from skin areas where it normally is present
- Telogen effluvium - diffuse hair loss that results in decreased hair density but does not progress to complete baldness
- Anagen effluvium - diffuse shedding of hairs, including growing hairs, that may progress to complete baldness
- Cicatricial alopecia - also known as scarring alopecia and characterized by slick, smooth scalp without any evidence of follicular openings of hair
- Androgenic alopecia - hair loss occurring in either sex, caused by stimulation of the hair roots by male hormones
- Alopecia areata - patchy, non-scarring hair loss
- Traction alopecia - patchy, initially non-scarring hair loss
- Tinea capitis - patches of hair broken off close to the scalp, with or without associated inflammation, caused by fungus infection
- System(s) affected: Skin/Exocrine
- Genetics: In Caucasians, androgenic alopecia follows a dominant trait with incomplete penetrance. The hereditary incidence is notable not only in men but also in women with a strong family history of baldness.
- Incidence/Prevalence in USA: 50% of Caucasian males by 50 years of age have noticeable male-pattern baldness. 37% of postmenopausal females show some evidence of hair loss.
- Predominant age: The incidence of androgenic alopecia increases with increasing age. Tinea capitis and traction alopecia are more common in children.
- Predominant sex: Male > Female
SIGNS AND SYMPTOMS
- Hair loss
- Pruritus (in tinea capitis)
- Scaling of the scalp (in tinea capitis)
- Broken hairs (in tinea capitis and traction alopecia)
- Tapered hair at the borders of the patch of alopecia (in alopecia areata)
- Easily removable hairs at the periphery of the patch of alopecia (in alopecia areata)
- Inflammation (in tinea capitis)
CAUSES
- Telogen effluvium
- Postpartum
- Drugs (oral contraceptives, anticoagulants, retinoids, beta blockers, chemotherapeutic agents, interferon)
- Stress (physical or psychological)
- Hormonal (hypo- or hyperthyroidism, hypopituitarism)
- Nutritional (malnutrition, iron deficiency, zinc deficiency)
- Diffuse alopecia areata
- Anagen effluvium
- Mycosis fungoides
- X-ray treatment
- Drugs (chemotherapeutic agents, allopurinol, levodopa, bromocriptine)
- Poisoning (bismuth, arsenic, gold, boric acid, thallium)
- Cicatricial alopecia
- Congenital and developmental defects
- Infection (leprosy, syphilis, varicella-zoster, cutaneous leishmaniasis)
- Basal cell carcinoma
- Epidermal nevi
- Physical agents (acids and alkali, burns, freezing, radiodermatitis)
- Cicatricial pemphigoid
- Lichen planus
- Sarcoidosis
- Androgenic alopecia
- Adrenal hyperplasia
- Polycystic ovaries
- Ovarian hyperplasia
- Carcinoid
- Pituitary hyperplasia
- Drugs (testosterone, danazol, ACTH, anabolic steroids, progesterones)
- Alopecia areata
- Unknown, but possibly autoimmune
- Traction alopecia
- Trichotillomania (direct self-pulling of the hair)
- Tight rollers or braids
- Tinea capitis
- Microsporum species
- Trichophyton species
RISK FACTORS
- Positive family history of baldness
- Physical or psychological stress
- Pregnancy
- Poor nutrition
DIAGNOSIS
LABORATORY
- Thyroid function tests
- Complete blood count (may reflect an underlying immunologic disorder)
- Free testosterone and dehydroepiandrosterone sulfate (DHEA-S) in women with androgenic alopecia
- Serum ferritin
- VDRL or RPR for syphilis
- Lymphocyte T and B cell number (sometimes low in patients with alopecia areata)
- Antifungal drugs may make KOH examination falsely negative
- Thyroid drugs and iodine preparations (including topicals) will alter thyroid function tests
PATHOLOGICAL FINDINGS
Scalp biopsy with routine microscopy and direct immunofluorescence will aid in the diagnosis of tinea capitis, diffuse alopecia areata, and the scarring alopecias due to lupus erythematosus, lichen planus, and sarcoidosis
SPECIAL TESTS
- Light hair-pull test (positive in alopecia areata)
- Direct microscopic examination of the hair shaft
- Potassium hydroxide (KOH) examination of the scale, if present (positive in tinea capitis)
- Fungal culture of the scale, if present
IMAGING
N/A
DIAGNOSTIC PROCEDURES
Scalp biopsy (sometimes)
TREATMENT
APPROPRIATE HEALTH CARE
Outpatient
GENERAL MEASURES
- Telogen effluvium - maximum shedding 3 months after the inciting event (medication, stress, nutritional deficiency) and recovery following correction of the cause. Rarely permanent baldness.
- Anagen effluvium - shedding begins days to a few weeks after the inciting event with recovery following correction of the cause. Rarely permanent baldness.
- Cicatricial alopecia - hair follicles are permanently damaged. Only effective treatment is surgical (graft transplantation, flap transplantation, or excision of the scarred area).
- Androgenic alopecia - by 12 months of using topical minoxidil, 39% of subjects reported moderate to marked hair growth. Other treatments for androgenic alopecia are surgical (hair transplantation, scalp reduction, transposition flap, and soft tissue expansion).
- Androgenic alopecia - by 12 months of using topical minoxidil, 39% of subjects reported moderate to marked hair growth. Other treatments for androgenic alopecia are surgical (hair transplantation, scalp reduction, transposition flap, and soft tissue expansion).
- Alopecia areata - usually the disease resolves within three years without treatment. Recurrences are, however, common.
- Traction alopecia - only with discontinuation of the hair pulling will the disorder resolve. Psychologic or psychiatric intervention may be necessary. Successful therapeutic approaches have included medications, behavior modification, and hypnosis.
- Tinea capitis - six to eight weeks of therapy are often necessary. Careful handwashing and laundering of head wear and towels.
SURGICAL MEASURES
N/A
ACTIVITY
Fully active
DIET
No special diet
PATIENT EDUCATION
National Alopecia Areata Foundation, 714 C Street, San Rafael, CA 94901
FOLLOW UP
PREVENTION/AVOIDANCE
N/A
POSSIBLE COMPLICATIONS
N/A
EXPECTED COURSE AND PROGNOSIS
- Telogen effluvium - rarely permanent baldness
- Anagen effluvium - rarely permanent baldness
- Cicatricial alopecia - the hair follicles are permanently damaged
- Androgenic alopecia - depends on treatment
- Alopecia areata - recurrences are common
- Traction alopecia - depends on behavior modification
- Tinea capitis - usually complete recovery
MISCELLANEOUS
ASSOCIATED CONDITIONS
Alopecia areata - Down syndrome, vitiligo, diabetes
AGE-RELATED FACTORS
Pediatric: Tinea capitis only common form of alopecia
Geriatric: Androgenic alopecia more common after 50
Others: N/A
PREGNANCY
Post partum hair loss is due to altered physiology during pregnancy
OTHER NOTES
N/A
ABBREVIATIONS
RPR = rapid plasma reagin
HPA = hypothalamic-pituitary axis
Clinical Investigations
- Cardiology
- Dermatology
- General Destistry
- Cardiology
- Dermatology
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