Dry & Itchy Scalp Presentation

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The document discusses the causes of a dry and itchy scalp. It describes the three main layers of the scalp: 1) the skin, which contains hair, sweat glands, and sebaceous glands; 2) the connective tissue underneath the skin, which connects the skin to muscles and contains nerves and blood vessels; and 3) the aponeurosis layer beneath the connective tissue, which provides attachment sites for underlying muscles.

Dry and Itchy Scalp

Dr Ali Naqi Syed
Presented to Hair Dressing Lecturers, UK
July, 2008

www.dralisyed.com

1

SCALP SKIN

Skin

Connective tissue:
Aponeurosis
Loose areolar tissue :
:
Pericranium

SKIN

www.dralisyed.com
2

2

Approach to a case of diffuse hair loss in females . Anagen effluvium- (a)Dystrophic (b)Loose anagen hair 2. Telogen effluvium – (a)acute telogen effluvium (b)Chronic telogen effluvium 3. Female pattern hair loss Primary CTE –represents a primary disorder and is a diagnosis of exclusion. Secondary CTE- secondary to variety of systemic disorders. Iron deficiency Other deficiency –protein calorie malnutrition ,zinc deficiency Thyroid diseases Metabolic diseases-chronic liver or renal failure, advanced malignancy, pancreatic disease and upper GI disorder with malabsorption SLE and other connective tissue disorders. HIV infection Drug induced

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Androgenetic alopecia (AGA) is a nonscarring progressive miniaturization of the hair follicle in genetically predisposed men and women, usually in a specific pattern distribution. Multifactorial and polygenetic etiology. Clinical features: -History of hair loss is - long standing slowly progressing reduction of hair density, diameter Miniaturization of hair Diminished anagen hair and increased telogen hair -Pattern of hair loss in male: Hamilton- Norwood type: recession of frontal hair line, latter followed by a vertex thinning with progression until top of the scalp is completely bald. -Pattern of hair loss in female: Centrofrontal hair loss with preservation of frontal hair line (Ludwig type) {figure - left} Christmas tree pattern {figure- right} -Family history of AGA often positive In female signs of hyperandrogenism should be evaluated gynecological history progesterone containing pills -To exclude other causes history should be taken regarding- Thyroid disease, Surgery, infection in last 6months to 1 year Drug history Iron deficiency Smoking UV exposure Hair color, cosmetics use. Allergic contact dermatitis Treatment: Androgenic alopecia is naturally progressive , so main strategy is to prevent progression and increase hair density. 1.Topical minoxidil: 2% for female and 5% spray for male 1 ml twice daily or half cup foam once daily. There is transitory telogen shedding within first 8 weeks observed. Response should be assessed after 6 months. If response occurs, will be continued as main stay of treatment. 2.Finasteride oral ad Dutasteride oral 1 mg finasteride per day prevents progression of AGA . 0.5 mg daily dutasteride is alternative. Combination of topical minoxidil and finasteride is good option Response evaluated after 6 months . not indicated in women. Contraindicated in pregnant and child bearing female. 3.Antiandrogen and estrogenic drugs: Given in hyperandrogenism in female. Not indicated in male. Spironolactone 100-200 mg daily Cyproterone acetate can be used 4.Hair transplantation 5.Low-level laser therapy 6.Miscellaneous: low level of evidence. Platelet rich plasma therapy and microneedling Herbal preparations Topical melatonin Nutritional supplement of- biotin, copper, zinc, aminoacids, micronutrients

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