Alopecia: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
No edit summary
 
(42 intermediate revisions by 10 users not shown)
Line 1: Line 1:
__NOTOC__
{{Infobox_Disease |
{{Infobox_Disease |
   Name          = {{PAGENAME}} |
   Name          = {{PAGENAME}} |
   Image          = Alopecia.jpg|
   Image          = Alopecia.jpg|
   Caption        = Alopecia as male pattern baldness at age 40|
   Caption        = Alopecia as male pattern baldness at age 40|
  DiseasesDB    = 14765 |
  ICD10          = {{ICD10|L|65|9|l|60}} |
  ICD9          = {{ICD9|704.09}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = 003246 |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = D000505 |
}}
}}
{{SI}}
{{Alopecia}}
{{CMG}}
'''For patient information, click [[Alopecia (patient information)|here]]'''


==Overview==
{{CMG}}; {{AE}} {{KS}} [[Ogechukwu Hannah Nnabude, MD]]
'''Alopecia''' is the resulting condition from the loss of hair, which is termed ''effluvium.'' It should be distinguished from [[baldness]], which is the ''lack'' of hair, including contexts where that absence is intentional.  (In some cases the terms are used interchangeably, and in some conditions such as [[trichotillomania]], where the loss of the hair is due to intentional acts, but the motive for that act is defined as a medical condition, it can be difficult to determine whether the label "alopecia" is appropriate.)


Alopecia is characterized by scarring or non-scarring. Scarring alopecia is caused by numerous dermatologic factors, including glabrous skin (non-hairy), and is very difficult to diagnose and manage.  Non-scarring alopecia is characterized by the absence of visible inflammation of the skin involved.
{{SK}} Atrichia; hair loss; bald; baldness; balding; hypotrichosis
==[[Alopecia overview|Overview]]==


== Vocabulary ==
==[[Alopecia historical perspective|Historical Perspective]]==
*[[Anagen]]:growth phase, lasts 2-3 years (80-90% of follicles at any given time)
*[[Catagen]]:involutional phase, lasts 2-3 weeks (1-3% of follicles)
*Telogen:resting phase, lasts 3-4 months (5-10% of follicles)
:*hair released from shaft and shed at end of telogen new cycle begins
:*mature root sheath of telogen hair = “club” at proximal end
*[[Terminal hair]]s: large shaft diameters, bulbs extend into subcutaneous fat
*[[Vellus hair]]s:smaller in caliber and length, less pigmented
*Indeterminate hairs:size/length between that of terminal and vellus hairs


== Risk Factors ==
==[[Alopecia classification|Classification]]==


*[[Drugs]]:
==[[Alopecia pathophysiology|Pathophysiology]]==
:*[[anticoagulants]]
:*[[anticonvulsants]]
:*[[antidepressants]]
:*[[beta-blockers]]
*[[Medical illness]]
:*[[Hyperthyroidism|Hyper]]/[[hypothyroidism]]
:*[[Nutritional deficiencies]]:  [[iron]], [[zinc]], [[protein]]
:*[[Connective tissue]] disorders:  [[SLE]], [[dermatomyositis]]


== Pathophysiology & Etiology==
==[[Alopecia causes|Causes]]==
'''Non Scarring'''<br>
''Diffuse''
*[[Androgenetic alopecia]]
:*most common (30-40% of men and women)
:*Genetically determined:  [[polygenic]] with [[variable penetrance]]
:*Shortening of anagen phase follicular miniaturization
:*Men: M-shaped pattern along frontal hairline (temporal loss progresses to midscalp)
:*Women:  more diffuse, can be difficult to distinguish from telogen effluvium
*[[Telogen effluvium]]
:*Reversible loss of mature, terminal hairs (few hundred per day)
:*[[Stress]]ful event (or [[medication]]) triggers transition of more anagen hairs into telogen phase
::*[[Childbirth]], [[fever]], severe [[infection]], severe [[psychologic stress]], major [[surgery]], [[crash diet]]
::*[[Drugs]]:  [[heparin]], [[antithyroid agents]], [[anticonvulsants]], [[hormones]]
:*Diffuse hair loss peaks 3-4 months after inciting event
:*Up to 30% of hairs must be lost before cosmetically apparent
*Anagen effluvium
:*Acute loss of anagen hair = 80-90% of hair
:*Occurs 10-14 days after treatment with [[antimitotic agents]] ([[chemo]])
''Focal''
*[[Alopecia areata]]:  incidence 1/1000
:*Smooth, discrete, circular areas of complete hair loss occurring over a few weeks
:*Exclamation point hairs:  hair root narrower than normal with less pigment
:*Can occur on any hair-bearing area; nails may also have proximal pitting
:*Usually reversible:  regrowth occurs over several months; 90% regrow within 2 years
:*Relapse occurs in up to 1/3
:*Decreased chance of regrowth/increased risk relapse if:
::*Prepubertal onset
::*Widespread involvement ([[alopecia totalis]] or [[Alopecia universalis|universalis]])
::*Duration > 5 years
::*History of [[atopy]]
:*Possible [[autoimmune]] mechanism:  bx shows [[T-cell]] infiltrates around hair follicles
:*Positive [[family history]] in 20%
*[[Syphilis]]
:*Moth-eaten, patchy pattern of loss (may be diffuse)
:*May be associated with [[skin lesions]] of [[secondary syphilis]], or may occur in [[Latent syphilis|latent stage]]
:*Full hairgrowth occurs after treatment of [[infection]]
*[[Trauma]]
:*[[Traction alopecia]]:  due to hairstyles that impose chronic tension on hair (braids)
:*Hair loss most prominent in areas of greatest tension (margins)
:*Fine, [[vellus hair]]s present in areas of absent [[terminal hair]]s
:*Regrowth can occur in early disease (few months-yrs), but not in late disease (years)
:*Chemical trauma:  repeated use of [[lye]]-containing straightening agents or hot oils for styling
:*[[Trichotillomania]]:  bizarre, asymmetric pattern of broken hairs of varying length
'''Scarring'''
*uncommon; hair loss is permanent
*erythematous papules, pustules, or scaling centered around follicles
*polytrichia = multiple hair shafts exiting a single enlarged orifice
*eventual obliteration of follicular orifices
*[[Tinea capitis]]
:*Scaling and [[inflammation]] in patchy areas of hair loss, +/- [[lymphadenopathy]]
:*Usually in children
:*KOH prep positive
*Central, centrifugal scarring alopecia (a.k.a. follicular degeneration syndrome, pseudopelade)
:*Symmetric involvement of central portion of scalp with outward expansion over months/yrs
:*May be associated with pustules (folliculitis decalvans)
:*Cause unknown-> emipiric [[Rx]] with [[steroids]], [[antibiotics]]
*[[Discoid lupus]]
:*[[Inflammation]] with plugged follicles, scale, abnormal scalp pigmentation
:*May have discoid [[lesion]]s elsewhere on body


== Diagnosis ==
==[[Alopecia differential diagnosis|Differentiating Alopecia from other Diseases]]==


*Pull test:  firm pull on 20-40 hairs should yield fallout of no more than 1 in 10 hairs
:*Increased # telogen hairs with depigmented proximal bulb:  [[telogen effluvium]]
:*Increased # hairs with no bulb:  breakage (hair fragility due to exogenous injury)
:*[[Anagen hair]]s with pigmented root:  likely excessive force
*Follicular units:  number of hairs produced per follicular orifice
:*Threes = normal for ages 20-40
:*Twos = normal for ages 40-60
:*Ones = normal for ages >60
:*Voids = follicular orifices w/o hairs suggests advanced [[androgenetic alopecia]] if no scarring


*Testing:minimal
==[[Alopecia epidemiology and demographics|Epidemiology and Demographics]]==
:*[[Medical illness]] suspected:  [[CBC]], [[TSH]], possibly [[ferritin]]
:*[[RPR]] if patchy or unexplained loss
:*KOH prep if patchy alopecia with scaling or [[inflammation]]


==Complete Differential Diagnosis for Alopecia==
==[[Alopecia risk factors|Risk Factors]]==
=== Non-Scarring Alopecia ===
* [[Adrenocortical insufficiency]] (primary or secondary)
* [[Anagen]] effluvium (anagen=growing hair)
* [[Cushing's syndrome]]
* Diffuse hair thinning due to [[metabolic]] causes
* [[Hyperthyroidism]]
* [[Hypoparathyroidism]]
* [[Hypothyroidism]]
* [[Pituitary insufficiency]]
* [[Secondary syphilis]]
* [[Sheehan's syndrome]]
* Temporary hair loss
*:* [[Pregnancy]]
*:* [[Malnutrition]]
*:*:* [[Malabsorption]]
*:*:* [[Protein deficiency]]
*:*:* [[Tryptophan]] deficiency
*:*:* [[Nontropical sprue]]
*:*:* [[Vitamin A deficiency]]
*:*:* [[Vitamin B deficiency]]
*:*:* [[Vitamin D deficiency]]
*:*:* [[Rickets]]
* [[Telogen effluvium]] (telogen=resting hair)
* [[Thyroiditis]]
* [[Trichotillomania]]


=== Scarring Alopecia ===
==[[Alopecia natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
* [[Amyloidosis]]
* Chronic disciform [[lupus erythematosis]]
* [[Congenital defect]]s
* [[Discoid Lupus Erythematosus]]
* Dissecting [[cellulitis]]
* [[Herpes zoster infection]]
* [[Infection]]
*:* [[Favus]]
*:* [[Typhoid Fever]]
*:* [[Leptospirosis]]
*:* [[Secondary syphilis]]
* Inflammatory [[dermatoses]]
* [[Lichen planopilaris]]
* [[Lymphoma]]
* [[Morphea]]
* [[Mycosis fungoides]]
* [[Neoplasm]]
* [[Neurodermatitis]]
* Physical or chemical agents:
*:* [[ACE inhibitors]]
*:* [[Allopurinol]]
*:* [[Androgens]]
*:* [[Anticoagulants]]
*:* [[Anticonvulsants]]
*:* [[Antimycotic agents]]
*:* [[Arsenic]]
*:* [[Azathioprine]]
*:* [[Beta blockers]]
*:* [[Borates]]
*:* [[Cadmium]]
*:* [[Chemotherapeutics]]
*:* [[Chlorambucil]]
*:* [[Cisplatin]]
*:* [[Clofibrate]]
*:* [[Cyclophosphamide]]
*:* [[Cytarabine]]
*:* [[Estrogens]]
*:* [[Fluororacil]]
*:* [[Gentamycin]]
*:* [[Gold compounds]]
*:* [[Heparins]]
*:* [[Indomethacin]]
*:* [[Levodopa]]
*:* [[Linolic acid]]
*:* [[Mercury]] and derivatives
*:* [[Methotrexate]]
*:* [[Niacin]]
*:* [[Oral contraceptives]]
*:* [[Propranolol]]
*:* [[Retinoids]]
*:* [[Salicylates]]
*:* [[Selenium]]
*:* [[Squalenes]]
*:* [[Steroids]]
*:* [[Thallium]]
*:* [[Undecylenic acid]]
*:* [[Vitamin A overdose]]
*:* [[Warfarin]]
* [[Pseudofolliculitis barbae]]
* [[Psoriasis]]
* [[Sarcoidosis]]
* [[Scleroderma]]
* [[Systemic Lupus Erythematosus]]


=== Miscellaneous ===
==Diagnosis==
* [[Addison's Disease]]
[[Alopecia diagnostic study of choice|Diagnostic study of choice]] | [[Alopecia history and symptoms|History and Symptoms]] | [[Alopecia physical examination|Physical Examination]] | [[Alopecia laboratory findings|Laboratory Findings]] | [[Alopecia electrocardiogram|Electrocardiogram]] | [[Alopecia x ray|X-Ray Findings]] | [[Alopecia echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Alopecia CT scan|CT-Scan Findings]] | [[Alopecia MRI|MRI Findings]] | [[Alopecia other imaging findings|Other Imaging Findings]] | [[Alopecia other diagnostic studies|Other Diagnostic Studies]]
* [[Anemia]]
* [[Cancer]]
* [[Diabetes Mellitus]]
* [[Pneumonia]]
* [[Scarlet Fever]]
* [[Schmidt's Syndrome]]
* [[Stress (medicine)|Stress]]
*:* [[Childbirth|Labor]]
*:* [[Surgery]]
* [[Androgen insensitivity syndrome|Testicular feminization syndrome]]
* [[Turner's Syndrome]]
* [[Typhoid fever]]
* Mechanical effects
:* Traction alopecia
:* Pressure alopecia
:*: Alopecia after extended bed rest
:* Trichotillomania (compulsion to pull out one’s own hair)
 
== History and Symptoms ==
*Age
:*Childhood: only 2 common diagnoses [[tinea capitis]], [[alopecia areata]]
:*Adulthood: [[tinea capitis]] rare; all the rest possible
*Duration
:*<1 year:  suggests [[telogen effluvium]] if diffuse loss
:*>1 year:  suggests [[androgenetic alopecia]] if diffuse loss
:*Pattern of loss
:*Shedding: “lots of hair coming out,” may be due to hair breakage or loss by the root
:*Thinning: scalp more visible without noticeable hair fallout, suggests [[androgenetic alopecia]]
:*[[Family history]]:  may be positive in [[androgenetic alopecia]], [[alopecia areata]]
:*Grooming practices:  can cause hair fragility/breakage
:*Chemical treatments (relaxers, perms, bleaching) most damaging; hair dye less so
Traction styling<br>
 
== Physical Examination ==
 
=== Appearance of the Patient ===
*[[Scalp]]
:*Normal or with features of [[scarring]]  
:*if scalp abnormal provide clues to dx
::*scaling
::*[[erythema]]
::*[[pustules]]
::*dyspigmentation
*Pattern:  diffuse or patchy
:*Male pattern (diffuse):bitemporal recession +/or vertex loss
:*Female pattern (diffuse):coronal thinning with preserved anterior hairline
:*Patchy:with preserved hair of variable length (breakage)
::*with exclamation point hairs ([[alopecia areata]])
::*with no hair ([[scarring]], traction, [[syphilis]], [[tinea]])
 
== Laboratory Findings ==
* [[Viral culture|Viral]] and [[bacterial cultures]]
* [[Prolactin]]
* [[Thyroid function tests]]
* [[Iron]] studies
* [[Dehydroepiandrosterone-sulfate]] ([[DHEA-S]])
* [[Testosterone]]
* [[Rapid plasma reagin]] ([[RPR]])
* [[Erythrocyte sedimentation rate]] ([[ESR]])
* [[Antinuclear antibodies]] ([[ANA]])


==Treatment==
==Treatment==
* Goal of [[treatment]] is to avoid future hair loss. 
[[Alopecia medical therapy|Medical Therapy]] | [[Alopecia surgery|Surgery]] | [[Alopecia primary prevention|Primary Prevention]] | [[Alopecia secondary prevention|Secondary Prevention]] | [[Alopecia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Alopecia future or investigational therapies|Future or Investigational Therapies]]
* [[Scarring]] hair loss prevents hair from going back.
* Wigs and [[hair transplants]]
* Anagen effluvium
*:* Treat [[illness]] or withdraw [[drug]]
* [[Telogen effluvium]]
*:* [[Stress]] the recovery is normal
* Treat underlying cause of alopecia
 
== Pharmacotherapy ==
 
=== Acute Pharmacotherapies ===
* [[Androgenetic alopecia]]
*:* For men, oral [[finasteride]] or [[topical]] [[minoxidil]]
*:* For women, [[antiandrogens]] if [[adrenal]] [[androgens]] are increased
* [[Tinea capitus]]/[[kerion]]
*:* Oral [[antifungals]]
* [[Alopecia areata]]
*:* [[Glucocorticoids]]
*:* [[Psoralen and ultraviolet A]] ([[PUVA]])
*:* Superpotent [[steriods]]
*:* [[Cyclosporine]]
*:* Intralesional [[steriod]] [[injections]]
 
=== Chronic Pharmacotherapies ===
*Topical [[minoxidil]] ([[Rogaine]], generic): 
:*only [[Rx]] approved for women as well as men
:*Increases duration of [[anagen]] and enlarges miniaturized follicles
:*Mechanism unclear
*Efficacy:
:*hair counts ~5x higher than placebo with use of 5% solution (men)
:*hair counts 45% higher with use of 5% solution compared with use of 2% solution (men)
:*hair counts returned to those of placebo group within 24 weeks after discontinuation [[Rx]] (men)
:*women:  increased hair growth in 60% vs. 40% with use of 2% soln vs. placebo
:*'''Advice for patients:'''
::*1 mL bid applied to dry [[scalp]] with spray or dropper; spread lightly w/finger
::*expect decreased loss w/in 2 mos, growth w/in 4-8 mos; stable at 1-1.5 yrs
::*best results if baldness present at vertex x < 5 years and < 10 cm diameter
::*cosmetically notable growth occurs in only 30-40%
::*Rx must continue indefinitely or regrown hair will be lost
::*[[Side effect]]s = rare contact or irritant dermatitis; no change [[blood pressure]], [[heart rate]] or weight


== Acknowledgements ==
== Acknowledgements ==
The content on this page was first contributed by: Steven Wiviott, M.D.
The content on this page was first contributed by: Steven Wiviott, M.D.


==References==
[http://www.calosol.com/alopecia.php Alopecia Types] - More information about alopecia and the various different types{{reflist}}
<br>
{{SIB}}
[[ro:Alopecia]]
[[ro:Alopecia]]
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}


[[Category:Disease state]]
[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Dermatology]]
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Latest revision as of 20:34, 15 December 2020

Alopecia
Alopecia as male pattern baldness at age 40

Alopecia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Alopecia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT Scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Laser Therapy

Concealing Hair Loss

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Alopecia On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Alopecia

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Alopecia

CDC on Alopecia

Alopecia in the news

Blogs on Alopecia

Directions to Hospitals Treating Alopecia

Risk calculators and risk factors for Alopecia

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Ogechukwu Hannah Nnabude, MD

Synonyms and keywords: Atrichia; hair loss; bald; baldness; balding; hypotrichosis

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Alopecia from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | Echocardiography and Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Acknowledgements

The content on this page was first contributed by: Steven Wiviott, M.D.

Template:WikiDoc Sources