HAIR DISORDERS

Hair disorders are amongst the common skin problems affecting all class of population at one or another time. Commonest of them are briefly mentioned here.

1)     ALOPECIA AREATA:

Definition and clinical features

A non-scarring auto immune disorder affecting any hair-bearing area. Typically, there is a sudden onset of solitary or multiple circular or oval bald areas,usually affecting the scalp.The residual hair follicles are visible confirming a lack of scarring.Diagnostic exclamation mark hairs may be visible at the margins of the lesion. The affected scalp is usually normal in color but may be erythematous.Hairs at the edge of the patch may be easily removed on slight traction. Spontaneous regrowth frequently occurs but the areas may spread peripherally and may eventually involve the whole scalp( Alopecia Totalis) and sometimes even facial & body hairs( Alopecia Universalis).

Rarely, a diffuse alopecia may be seen without discrete bald patches.Nail changes may also occur as fine regular pitting or a roughened sand paper appearance(Trachyonychia).

Epidemiology

A common disorder affecting all races and either sex equally. It occurs at any age,with maximum incidence between 10-30 years.

Differential Diagnosis

Fungal infection of scalp—may be confirmed by Wood’s light and mycological examination.Trichotillomania—shows broken hairs of varying length.Telogen effluvium also causes diffuse non-scarring alopecia.

Investigations

An autoimmune basis is suggested.Organ specific antibodies may be demonstrated. A family history of alopecia areata occurs in 20-50% of patients. Scalp biopsy is supportive.

Management

Spontaneous regrowth may occur in localized disease.Topical,intralesional & systemic corticosteroids can produce temporary regrowth.Contact sensitization therapy using irritants or allergens & PUVA are also used. The more extensive the hair loss, the less likely the prospect of regrowth.Extensive involvement, atopy, other autoimmune diseases, nail involvement and onset in childhood are poor prognostic factors.

2)    TELOGEN EFFLUVIUM:

Definition and clinical features

Sudden extensive hair loss occurring 4-8 weeks following the precipitating event. Several hundred hairs may be lost per day, producing an alopecia diffusely affecting the entire scalp.Pre-existing androgenetic alopecia may become more evident, the scalp appears normal and duration is variable(recovery is usually complete within 6 months).

Epidemiology

Occurs at any age but most frequently in young adults.Female:Male ratio is 2:1.

Differential Diagnosis

Diffuse scalp alopecia can also occur with alopecia areata, hypothyroidism,iron deficiency,anaemia,and may be caused by drugs.

Investigations

Trichogram (plucked scalp hairs) will show an increase in the number of telogen hairs and reduction in anagen hairs.

Special points

Acute precipitating factors include childbirth,pyrexia, haemorrhage,changing or discontinuing hormonal therapy(including oral contraceptive pills),eating disorders,strict dieting and nutritional deficiencies.

3)   ANDROGENETIC ALOPECIA(MALE PATTERN BALDNESS):

Definition and clinical features

Miniaturisation of hair follicle through successive cycles affecting the fronto-vertex and crown of the scalp, producing a gradual conversion of terminal to villus hairs. The scalp hair loss begins with recession at the temples and the frontal hairline in men(Hamilton pattern) and thinning over the crown and vertex. This slowly progresses over years, in severe cases hair remains at the occiput and sides of the scalp alone.Vellus hair may remain on the vertex.In women(Ludwig pattern) the frontal hairline is frequently kept but a difuse thinning occurs over the top of the scalp.In women, associated hirsutism,acne vulgaris,obesity and irregular menses may suggest an underlying polycystic ovarian syndrome.

Epidemiology

Affects all races world wide, occurring physiologically from the late teens to the 50s.In women, occurs usually post menopausally.The condition requires genetic predisposition and normal amounts of circulating plasma androgens.

Differential Diagnosis

Telogen effluvium may produce diffuse alopecia but usually affects the back and sides of the scalp as well as the fronto-vertex.Hair styles producing traction may cause recession of the anterior hair margin.

Investigations

In women,hormone profile and ovarian ultrasound scan may confirm underlying polycystic ovarian syndrome.

Management

Treatment includes topical measures such as Minoxidil lotion, systemic antiandrogens in women or scalp reduction or hair transplantation surgery.

4)    TRICHOTILLOMANIA:

Definition and clinical features

Self-induced alopecia produced by deliberate trauma to the hair. A diffuse area of thinned hair with a poorly defined margin.Scalp skin is normal.Affected hairs show breakage of varying lengths.The area may be solitary or multiple. A normal,long haired margin often remains.The scalp is usually affected but hair loss may also occur in the eyebrows, eyelashes or body hair.

Epidemiology

Trichotillomaia occurs more frequently in females than males(3:1) but may occur at any age.Most frequently it occurs between the ages of ages of 5 & 10 years developing as a habit tic.In older women it may be a sign of underlying psychiatric disorder.Anxiety & emotional stress are precipitating factors.

Differential Diagnosis

Alopecia areata produces more discrete,completely bald areas of patches.Tinea capitis can produce broken hairs,scaling and inflammation may be present.

Investigations

Hair microscopy will reveal broken hairs of varying lengths.

Management

Occlusion of the area often allows recovery.Children frequently outgrow the habit tic,whilst in adults psychiatric therapy may be required.

BY:

DR CHETAN LALSETA

M.D.(SKIN & V.D.)

CONSULTANT DERMATOLOGIST & COSMETOLOGIST

MIRROR LASER & COSMETIC CENTRE,

SHRADDHA HOSPITAL,

INDIRA CIRCLE CHOWK,

RAJKOT-04

CONTACT NO: 98251 99585