STAGES OF HAIR GROWTH ANAGEN CATAGEN TELOGEN ALPOECIA SCARRING ALOPECIA NON SCARRING ALOPECIA ANDROGENIC ALOPECIA MALE AND FEMALE PATTERN ALOPECIA MUCINOSA HAMILTON NORWOOD SCALE LUDWIG SCALE ALOPECIA AREATA TURNING GREY PHENOMENON

1. HAIR
TONY SCARIA 2010
KMC

2. Hair

3. Hair stages  ACT
ANAGEN
• Hair growth phase
• Vigorous mitotic activity
• Melanogenesis +
• 75-80% are in anagen phase
• 3 years
CATAGEN
• Transitional (regressing)
phase
• 3 weeks
• 1% HAIRS
TELOGEN
• Resting /degenerative
stage
• 3 months
• 15 % HAIR

4. EYEBROWS HAVE SHORT ANAGEN
PHASE (PHASE OF
GROWTH)THERFORE DONOT
GROW BEYOND CERTAIN LENGTH

5. TRICHOGRAM STUDY IN HAIR FOLLICLE(STUDY OF
HAIR FOLLICLE UNDER MAGNIFICATION)
ANAGEN
• ANGULATED
(HOCKEY
STICK
SHAPED)
• DARK IN
COLOUR
CATAGEN
• CLUBBING
• DARK IN
COLUR
TELOGEN
• CLUBBING
• WHITE
COLOUR

7. • Grows 1cm /month = 0.4 mm/day
• Terminal hair  hair / beard
• Loss of 50-100 scalp hair  normal
• Hair follicles are absent
• IN palms, soles and glabrous skin (genitalia)

8. • Obstruction of hair root  boil

9. Hair loss
Alopecia
Nonscarring
alopecia
Scarring alopecia

10. Nonscarring alopecia
• Primary skin disorder
• Androgenic alopecia
• MC type of alopecia***
• Telogen effluvium
• Alopecia areata (exclamation mark hairs)
• Traumatic alopecia
• Trichitillomania ,early traction alopecia
• Tinea capitis
• Systemic diseases
• SLE (lupus hairs)
• Secondary syphilis
• Hypo/hyperthyroidism
• Hypopituitarism
• Deficiency of protein,Zn
• HIV infn
• Drugs
• Warfarin,Heparin
• Vitamin A,isotretinoin,aciretin
• Li , b blockers,
• colchicine.,amphetamine

11. Androgenic alopecia
• MC type of alopecia in both men and women (after menopause)
• Short anagen phase
• Patterened hair loss
• non – scarring
• ↑sensitivity of the affected hair to effects of testosterone DHT (dihydrotestosterone )
• C/F
• Miniaturisation of hair along midline of scalp
• Males have bitemporal recession
• Crown involvement (Hamilton norwood scale)
• Rx
• Topical minoxidil
• Finasteride (only men)
• Spironolactone (in female)
• Scalp Sx, hair transplant

12. 3 patterns of hair loss
Female pattern

13. Male & female pattern
• Receding of frontal hair line
• And also from vertex
• No receding of frontal hair
line
• From vertex & occiput

14. Treatment
• Topical
• Minoxidil
• MOA  increase androgen phase
• Systemic
• 5 α reductase inhibitors
• Finsteride
• Dutasteride
• androgen receptor blocker
• Flutamide
• Antiandrogens
• Cyproterone acetate
• Surgical
• Hair transplantation

15. 5 α reductase converts testosterone to DHT
-
• Finasteride

16. Finasteride
• Noncompetitive irreversible
• Highly selective antagonist of 5 alpha reductase type 2
• PSA values Reduced by 50 % 
• S/e
• Impotence , gynaecomatia, breast cancer, prostate cancer

17. Cyproterone acetate
• Androgen receptor blocker, potent progestrin and has
antigonadotropic effect
• Dianette
• Mixture of antiandrogen (cyproterone acetate) + esrogen (ethinyl estra doiol)

18. Alopecia mucinosa
• Nonscarring alopecia
• Mucin deposition in hair follicles and sebaceous glands causing
epithelial reticular degeneration
• In face and scalp

19. Male pattern baldness Hamilton – norwood
scale
Recession of frontal hair
line and balding of scalp
vertex

20. Ludwig scale  female hair loss
More diffuse process
where there is diffuse
reduction of hair density
involving crown and
frontal scalp with
maintenance of frontal
hair line

21. Alopecia areata
• Recurrent nonscarring
• Patchy hair loss
• Turning grey phenomenon
• Reversal of anagen ; telogen ratio
• Affect any hair bearing area
• Scalp ***
• Well circumscribed areas of hair loss
• a/w
• Autoimmune disease (CD8), atopic dermatitis,down’s

22. Alopecia areata
• exclamation mark hairs
• Broken off hairs of 3-4 mm
long which taper
off towards scalp
• Broad distal & thin proximal
exclamation mark hairs

23. Exclamation mark with turning grey
phenomenonn

24. Alopecia areata histology
• Swarm of bus appearance
• Germinative zone of hair follicle are surrounded by t lymphocytes
• Peribulbar lymphocytic infiltrate
• Swarm of bees

25. Forms
• Alopecia universalis
• Complete loss of all body hair + scalp
• Alopecia totalis
• Loss of scalp hair

26. Ophiasis pattern of AA
• Hair loss on sides and lower back of scalp

27. Sisaipho pattern of AA
• Lower back and sides are spared

28. Go white over night alopecia totalis
• White / grey hair not affected in alopecia areata
• Black hair will fall off

29. Nail involvement in AA
• Pitting mC
• 20 nail dystrophy

30. • Rx of AA
• Intralesional & topical glucocorticoids
• Topical anthralin or tazarotene
• Topical calcineurin inhibitors
• Tacrolimus
• Pimerolimus
• Topical contact sensitisers
• Diphencyprone,squaric acid dibutylester
• Systemic steroid
• Steroid sparing agent
• Levamisole  antihelminthic with immunomodulator
• Phototherapy  alopecia univeralis

31. Moth eaten alopecia
• 2* syphilis

32. Telogen effluvium
• Acute Diffuse REVERSIBLE hair loss
• > 150 scalp hair with bulb
• following stress (high grade or recurrent fever/ severe infection/crash
dieting /chronic iron deficiency / postpartum ) after 3 months (DURATION
OF TELOGEN PHASE)
• Growing anagen phase of several adjoining hair follicle is aborted and these hair
follicles enter catagen phase at the same time (synchronous) followed by telogen
• PREMATURE ENTRY OF 20 % ANAGEN HAIR FOLLICLES IN TO TELOGEN HAIR PHASE
• Last for 3 months
• Reassurance  reversible

33. Telogen effluvium

34. Anagen effluvium
• Increased anagen hair loss (instead of usual telogen hair loss)
• ACTIVELY DIVIDING HAIR CELLS ARE LOST
• Rapid in onset
• 2- 3 weeks after exposure to cause
• Tapered fracture of hair shaft +
• Causes
• Radiotherapy to head
• Systemic chemotherapy
• Severe PEM
• Iron deficiency anemia
• Intoxication ( Hg, boric acid, thallium,cochicine)
• Drugs (tamoxifen,doxorubicin)

35. Anagen effluvium

36. Traumatic alopecia

37. Traumatic alopecia
• Compulsive hair pulling
• Bizarre pattern of hair loss
• Broken at various distances from scalp
• Histology
• Numerous empty canals

38. Scarring (cicatrizing alopecia)
• Primary skin disorder
• Lichen planus
• Folliculitis decalvans
• Linear scleroderma
• Cutaneous lupus
• Systemic disease
• Discoid lupus erythematosus
• Sarcoidosis
• Cutaneous metastasis
• Herpes zoster
• Bacterial & fungal infn

39. Aplasia cutis congenita
• Most common congenital cicatrical alopecia