Sat 1025-hair-management-too-much-too-little- -park
Upcoming SlideShare
Loading in...5
×
 

Sat 1025-hair-management-too-much-too-little- -park

on

  • 92 views

 

Statistics

Views

Total Views
92
Views on SlideShare
92
Embed Views
0

Actions

Likes
0
Downloads
0
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Sat 1025-hair-management-too-much-too-little- -park Sat 1025-hair-management-too-much-too-little- -park Document Transcript

  • 5/28/2014 1  Dr Shehla Ebrahim. MD,CCFP,FCFP. ( special interest dermatology)  I have no relevant conflicts of interest.  I have received an honorarium from the BC college for presenting this talk.
  • 5/28/2014 2  A full day of Hair loss.  Its going to be a long day  Non scarring Alopecia -MPHL/FPHL -Telogen Effluvium. -Alopecia Areata.  When is it more than just hair loss.  Clinical Scenarios and Key Messages
  • 5/28/2014 3
  • 5/28/2014 4  Onset and duration. “When was the last time you had a normal head of hair”?
  • 5/28/2014 5  Strong Family history is supportive of MPHL
  • 5/28/2014 6
  • 5/28/2014 7
  • 5/28/2014 8  Regularity of menses.  Fertility.  NOTE PATTERN OF HAIR LOSS.  Examine the scalp skin for inflammation, scaling, patches.  Examine the eyebrows, facial axillary and pubic hair.  Check for hirsuitism is suspected by history.
  • 5/28/2014 9 HAIR CYCLE ANAGEN 3 YEARS CATAGEN 3 Weeks TELOGEN 3MONTHS ANAGENANAGEN ANAGEN TELOGEN FEMALE PATTERN HAIR LOSS MALE PATTERN HAIR LOSS TELOGEN EFFLUVIUM ALOPECIA AREATA ANDROGEN EXCESS
  • 5/28/2014 10  95% of hair loss .  50% of men and 40% of women. CLINICAL PEARL  They have completely normal androgen levels. CLINICAL PEARL Retention of the frontal hair line
  • 5/28/2014 11
  • 5/28/2014 12 HAIR CYCLE ANAGEN 3 YEARS CATAGEN 3 WEEKS TELOGEN 3 MONTHS ANAGENANAGEN ANAGEN TELOGEN  TSH.  Ferritin - No studies showing reversal of hair loss with iron supplementation. - Keep Ferritin above 50 ug/L Trost et al JAAD 2006;54(4) 824-844.
  • 5/28/2014 13  Topical Minoxidil 2% and 5%  Mainly acts on the hair cycle by lengthening the duration of the anagen plus enlarges the miniaturized hair follicles Messenger,AG Brit J dermatology 2004;150:186:194.  Adverse effects (higher 5%) - Irritation. - Contact Dermatitis (propyleneglycol) -NonVirilising Hypertrichosis. - High degree of variability in cosmetic acceptance. - 5% foam OD vs. 2% BID. Lucky et al JAAD 2004:50;541-553
  • 5/28/2014 14  Androgen receptor blocker and inhibits steroid androgen production.  Threshold of response acne>Hirsuitism> FPHL  Concurrent BCP -breast tenderness. - Feminization of male foetus  200 mg per day. Sinclair, R Brit J dermatology 2005;152:466-473
  • 5/28/2014 15  Thinning is Bitemporal +/-the crown of the scalp. CLINICAL PEARL • The sides are spared
  • 5/28/2014 16  Type 11, 5 alpha reductase inhibitor.  Inhibits the conversion of testosterone to DHT.  1 mg in MPHL.( Kaufman et al) -benefits are temporary. - Decreased libido and ED.  Not indicated for use in women. Canadian Family PhysicianVol 46 July 2000 FEMALE PATTERN HAIR LOSS MALE PATTERN HAIR LOSS TELOGEN EFFLUVIUM ALOPECIA AREATA ANDROGEN EXCESS
  • 5/28/2014 17  Febrile illness  Childbirth  Severe psychological stress  Major surgery  Hypo or hyperthyroidism  Iron deficiency anaemia  Crash diets  Drugs HAIR CYCLE ANAGEN 3 YEARS CATAGEN 3 WEEKS TELOGEN 3 MONTHS ANAGEN TELOGEN
  • 5/28/2014 18
  • 5/28/2014 19  Identify specific cause.  Complete recovery occurs in 4-6 months.  Minoxidil 5%
  • 5/28/2014 20 FEMALE PATTERN HAIR LOSS MALE PATTERN HAIR LOSS TELOGEN EFFLUVIUM ALOPECIA AREATA ANDROGEN EXCESS  Polygenic Autoimmune disorder.  It attacks the anagen hair follicles of the scalp,face and body  Majority Appear sporadically and it can appear without a family history. Canadian family PhysicianVol 46,July 2000
  • 5/28/2014 21  AA is associated with other AA diseases such as vitiligo,Diabetes,Thyroid disease, pernicious anemia  Spontaneous remissions can occur. Dermatology in PracticeVol 11 no 5  Patchy. (Most common)  Diffuse.  Confluent.  Aphyiais.
  • 5/28/2014 22
  • 5/28/2014 23
  • 5/28/2014 24  T cell mediated disorder.  Immune privilege of the hair follicle is lost.  Once activated, the cytotoxicT cells produce inflammatory cytokines and IL which attack the anagen hair follicles of the scalp, eyebrows, eyelashes and body  Nail Dystrophy (pitting, ridging, thinning)  Exclamation marks, are seen at the periphery of the patch  Color changes in the hair
  • 5/28/2014 25
  • 5/28/2014 26  ADULTS WITH < 50% HAIR LOSS -Observe for several months - Intralesional steroids.kenalog q4-6 weeks - Potent topical steroids.OD for 3 months - +/- Minoxidil  ADULTS WITH > 50% HAIR LOSS. -Topical immunotherapy with DPCP (diphenylcyclopropenone) -Psoralen and Ultraviolet A (PUVA) - Pulsed Oral Steroids
  • 5/28/2014 27 FEMALE PATTERN HAIR LOSS MALE PATTERN HAIR LOSS TELOGEN EFFLUVIUM ALOPECIA AREATA ANDROGEN EXCESS  Most women with FPA show no clinical or biochemical evidence of hair loss. -Hypersensitive to physiologic concentration of androgens  When to evaluate for PCOS or metabolic Syndrome?
  • 5/28/2014 28  Increased Facial Seborrhea  Acne that fails to respond to standard therapies. Localized to the jaw line and neck  Hirsuitism; upper lip, chin breast and linea alba  Androgenic Alopecia, early onset < 35 years.  Menstrual Irregularities.  Infertility.  Galactorrhea  Virilization
  • 5/28/2014 29  Polycystic ovary Syndrome(90%) Prevalence 5-10%  Tumours of the ovary or adrenal gland(<0.5%  Hyperprolactinemia(2.3%)  Congenital adrenal hyperplasia (1.3%)  Cushings syndrome  Androgenic medications (danazol, anabolic steroids, progestin releasing IUD Glint &Anderson,gynecol endocrinol 2010:26:281-96  Testosterone (free and total)  Sex hormone binding globulin (SHBG)  Dehydroepiandrosterone sulphate(DHEAS)  Prolactin  LH/FSH  Fasting Glucose/insulin  Lipid profile. Ding,EL et al NEJM 2009:361:1152-1163
  • 5/28/2014 30 MH.Age 23  Testosterone 2.0 nmol/L (0.5-3.2)  Testosterone Free 180 pmol/l ( 5-60)  SHBG 3 nmol/L ( 5-100)  Cholestrol 7.16 H ( 2-4.60 nmol/L)  LDL 4.83 H (1.50-3.00)  TGA 3.9 (<2.21)  HDH 0.19 nmol/L (1.19)
  • 5/28/2014 31  Weight loss  Oral Contraceptives  Anti androgen medications -Spironalactone -Cyproterone Acetate  Insulin Sensitizing medications. -Metformin
  • 5/28/2014 32  A 20 year old female with steadily thinning hair over the past several years.  Otherwise in good health.
  • 5/28/2014 33 FEMALE PATTERN HAIR LOSS  45 year old woman with considerable hair loss during the last 6 months.  “Massive” amounts of hair are clogging the shower drain every day  During the same period of time she has felt “depressed "fatigued and lacking in her usual energy
  • 5/28/2014 34 TELOGEN EFFLUVIUM
  • 5/28/2014 35  36 year old man has noticed bald patches of hair loss on his scalp and more recently his beard area.  He is otherwise in good health.
  • 5/28/2014 36 ALOPECIA AREATA  23 year old overweight female complaining of scalp thinning,increased facial hair.  History of irregular periods since puberty.  Family history balding.
  • 5/28/2014 37
  • 5/28/2014 38 ANDROGEN EXCESS MPHL/FPHL  Patients with FPHL/MPHL have Normal androgen levels.  Pattern of hair loss isTHINNING -Retention of frontal hair line FPA - Sides are spared in MPHL
  • 5/28/2014 39 Telogen Effluvium  Pattern of hair loss is diffuse shedding and involves the entire scalp  Re growth occurs in 4-6 months  Alopecia Areata  Look for exclammation marks,white hairs and nail changes.  Wait for 6-9 months as spontaneous resolution is common.
  • 5/28/2014 40  Suspect androgen excess if: -Features of SAHA are present - Screen for PCOS/FreeTestosterone - Treat with weight loss, Antiandrogen  Do not underestimate the psychological impact that Hair loss has on your patients.  These patients feel vulnerable as hair gives them character and definition.  National AA foundation.  Local wig makers.  Eyebrow and Eyelid tattooing
  • 5/28/2014 41 Thank you Photo courtesy of www.DermNet NZ.org sebrahim@telus.net
  • 5/28/2014 42  Trichotillomania.  Traction Alopecia. •A compulsion to pull/pluck hair repetitively. •Impulse control disorder •7x more frequent in children. •With increasing age, girls
  • 5/28/2014 43
  • 5/28/2014 44
  • 5/28/2014 45  Spontaneous resolution.  Clomipramine vs desipramine.
  • 5/28/2014 46