Downloaded 232 times
Uploaded byAmr Eldakroury
Hair Disorders
The document outlines common hair disorders, their management in primary health care, and referral criteria, emphasizing educational intent and evidence-based recommendations. It covers various conditions like alopecia areata, androgenic alopecia, and telogen effluvium, detailing their symptoms, assessments, and treatment options. Clinical cases illustrate diagnostic considerations and management strategies for hair loss disorders.
More Related Content
More from Amr Eldakroury
Hair Disorders
- 1. Hair Disorders Primary HealthCare Dr. Wajahat Mohammad Consultant Family Medicine
- 2. Disclosure Of Conflictof Interest I Dr. Wajahat Mohammad DO NOT have a financial interest/arrangement or affiliation with anyone in relation to this program/presentation/organization that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. Purely educational intent Recommendations are based on current evidence References provided where possible
- 3. Summary Common HairLoss disorders Primary care management of hair loss disorders Referral Criteria for hair loss disorders Beyond Hair Loss ‘the symptom’
- 4.
- 6. Hair Cycle Anagen- Growth (2-6 years) Catagen - Involution (10-21 days) Telogen - Resting (90-100 days) Exogen - Shedding
- 7. Hair Disorders More Hair Hypertrichosis (Ambras Syndrome) Hirsutism Less Hair Hair Loss Trichodystrophy
- 8. Hair Loss Categorization NonScarring Alopecia Areata Androgen Alopecia Telogen Effluvium Trcihotillomania Ringworm Traction Alopecia * Visible follicles Scarring Chronic Discoid Lupus Erythematosus Lichen Planus Lichen Scelorosus Morphea ( localised scleroderma) Others cancers/trauma/Infection * Follicles not visible
- 9. Assessment - History Onset, Duration and Precipitants Pattern ( Diffuse vs Patchy) Scarring Shedding vs Breaking vs Thinning Medical History Drug History Family History Hair Care Diet
- 10. Assessment - Examination Inspection Scalp: Scarring? Scaly? Erythema? Pattern: Diffuse Patchy Density Hair Quality Pull Test
- 11. Assessment Investigation Ferritin Hormones Sex Hormones ANA Syphilis Scalp Scraping
- 12. Clinical Vignette 35year old male 2 months history of Hair loss No itching No trauma No other medical conditions Diagnosis? Treatment Options Would you Refer onward?
- 13. Alopecia Areata ChronicInflammatory Dermatological Disorder Unknown etiology Factors: Autoimmune, Environment and Genetics Non scarring Patchy or Complete 80% regrowth in Mild Alopecia 34-40% Recover in 1 year Progressive 14-25%
- 14. Prognostication Multiple lesionson scalp margins Involvement of Eyebrows and eye lashes Nail Changes Associated Atopy Childhood Onset Chronic Extensive disease Downs Syndrome Associated Autoimmune diseases
- 15. Management No Treatment– an option Topical steroids Intralesional Triamcinolone Topical Immunotherapy ( Diphenylcyclopropenone, squaric acid dibutyl ester or dinitrochlorobenzene)) Topical Minoxidil 2% and 5% PUVA Anthralin Methotrexate, azathioprine, oral steroids Less effective- TNF Alpha Inhibitors, Statins, chloroquine Ineffective- Tacrolimus, Cyclosporin –topical
- 16. Referral Criteria Extensivedisease Diagnostic Uncertainty Psychological Distress Pregnant and breast feeding Topical Treatment not helpful Wig is required
- 17. Clinical Vignette 40year lady gradual loss of hair over 6 months Diabetes Mellitus Height 155 cm Weight 92 kg What Else do we ask? Diagnosis? Treatment? Will you refer?
- 18. Female Pattern HairLoss Andro-Genic Alopecia in women Unclear etiology Suspected disorder of sensitivity to Dihydrotestosterone 3-6% in <30 yrs age, 29-42% in >70 yrs age Frontal Hair line Spared in women Usually progressive once develops Very Rare progression to complete Baldness
- 19. Management Baseline Testosteroneand Dehydroepiandrosterone sulfate Topical Monoxidil is first line, 2% to 5% BD, can take 4 months to show improvement. Antiandrogen medication Spironolactone Cyproterone acetate Finasteride Psychological support Surgical Options
- 20. Clinical Vignette 25year lady Losing handsful of hair Sudden onset Has a 2 month old son with her Feeling Tired What else is relevant to ask? Management? What Tests?
- 21. Telogen Effluvium Accelerationof Hair Loss cycle More hair in telogen phase than anagen phase (upto 50%) Usually triggers found from history Pull Test Positive
- 22. Triggers Acute orchronic major illness Febrile illness Major surgery Childbirth (telogen gravidarum) Rapid weight loss Protein or caloric dietary restriction Congenital or acquired zinc deficiency Significant emotional stress Collagen vascular disease Endocrine disorders (eg, hypothyroidism or hyperthyroidism) Drugs, supplements, or toxins Inflammatory conditions of the scalp (eg, seborrheic dermatitis) Infectious conditions that affect the scalp (eg, fungal, bacterial, or spirochetal) Iron deficiency anemia Nutritional deficiencies
- 23. Drugs associated withTelogen Effluvium Allopurinol Androgens Anticholesterol agents (statins) Anticoagulants Anticonvulsants Antifungals Antihistamines (H2) Antiinflammatory agents Antimitotic agents Antithyroid agents Beta blockers Dopa Ergots Heavy metals Hormones (oral contraceptives, hormone replacement therapy) Immunomodulators Retinoids Psychotropics Minoxidil Selective estrogen receptor modulators and phytoestrogen
- 24. Management of Telogeneffluvium Investigate with CBC, CMP, TFT and Ferritin Treat Underlying Cause Psychological Support Cosmetic advice Topical Minoxidil
- 25. Beyond Hair Loss Effects of hair loss Interpretation of hair loss Socio-economic consequences
- 26.
- 27.
- 28.
- 29.
- 30.
- 31.
- 32.
- 33.
- 34.
- 35.
- 36.
- 37.
- 38.
- 39.
- 40.
- 41.
- 42.
- 43.
- 44.
- 45. References: KARYN SPRINGER,M.D.,MATTHEWBROWN,M.D.,and DANIEL L.STULBERG,M.D. Utah Valley Family Practice Residency,Provo,Utah, Am Fam Physician 2003;68:93- 102,107-8 HUNT N, McHale S, Psychological Impact of Alopecia, BMJ 2005, 331(7522):951- 953 BLUME-PEYTAARI U et al: Guideline for diagnostic evaluation in androgenetic alopecia in men, women and adolescents, British Journal of Drematology 2011, 164 (1):5-15 UKPDCS GP Notebook Uptodate