Term
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Definition
Time of onset
Medications taken
Recent emotional of physical stress (surgery, death in family, job loss)
Grooming techniques
Family history of baldness or hair disorders |
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Term
| Hair disorders physical exam: |
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Definition
- observe general pattern of hair loss (patchy or diffuse)
- NOTE SCARRING VS. NON-SCARRING |
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Term
| Scarring indicates __ hair loss. A __ __ biosy is done to determine whether it is scarring or non-scarring area hair loss. |
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Definition
permanent
4 mm punch biopsy
(look to see if there are hair bulbs on scalp, if smooth probably permanent balding) |
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Term
| The normal hair cycle is disturbed by an emotionally or physiologically stressful event. Growing anagen hair s are prematurely converted to resting telogen hairs, which are subsequently shed. |
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Definition
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Term
| Possible causes of Telogen Effluvium: |
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Definition
High fever
Childbirth
Chronic illness
Major surgery
Anemia
Severe emotional disorders
Crash diets (gastric bypass, etc…)
Hypothyroidism
Drugs:
Starting, stopping or changing birth control pills/hormone replacement
Warfarin, Heparin, B-blockers, Lithium, ACE-inhibitors, Retinoids (Isotretinoin, Acitretin) |
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Term
| If suspect telogen effluvium, order a __ to make sure the patient is not anemic. |
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Definition
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Term
| With telogen effluvium hair loss occurs _ to __ __ after the inciting event. |
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Definition
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Term
| Post-partum patient comes in complaining that "hair is coming out in handfuls" after brushing and showering. On physical examination you find diffuse hair thinning of the scalp (not at first readily apparent). The scalp is normal with NO scarring or erythema. Nails, hair on rest of body, and teeth are normal. Gentle hair pull testing can be used to confirm excess shedding of more than 3 hairs from multiple scalp areas. |
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Definition
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Term
| Telogen Effluvium therapy: |
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Definition
- resolves in most patients within 2-6 months on own
- if stressor continues, a chronic telogen effluvium may develop lasting more than 5 years |
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Term
In women, should have normal hairline on forehead then thinning near the partline and behind front of hairline.
Men will get the M pattern in the front and vertex balding. |
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Definition
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Term
| Androgenic alopecia aka __ __ is genetically determined and androgen dependent. Hair follicles in the bald areas of the scalp have increased level of activity of _ __ ___, which causes increased levels of DHT which __ the hair cycle and ___ scalp follicles through an uknown mechanism. |
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Definition
- common baldness
- 5-alpha-reductase
- shortens the hair cycle
- miniaturizes |
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Term
| Androgenic alopecia occurs in both __ and __ who are genetically predisposed. This disorder is __ and involves the __ and ____ regions of the scal. |
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Definition
- men and women
- NON-SCARRING
- vertex and frototemporal regions |
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Term
| Androgenic alopecia Incidence: most common in male caucasians, but approximately 50% of women over 40y/o will experience this patterned hair thinning as well. |
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Definition
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Term
| The onset and progression of androgenic alopecia is gradual. Can begin at any age after puberty. Ususally first seen as temporal recession b/w ages 20 and 30. |
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Definition
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Term
| In areas of baldness, dark terminal hairs are replaced by finer, miniaturized vellus-like hairs, which then eventually become atrophic, leaving a smooth shiny scalp. |
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Definition
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Term
Men – begins with bitemporal recession, followed by balding of the vertex.
Women – diffuse thinning over the crown of the scalp with an intact frontal hairline. Will see a gradual widening of the part width on the crown at first, then marked diffuse thinning. |
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Definition
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Term
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Definition
Usually straightforward in men, but must consider possible hormonal abnormalities in women – particularly when accompanied by acne or hirsutism.
Question about menstrual irregularities, infertility, hypothyroidism.
May consider screening for serum-free and total testosterone and DHEAS (dehydroepiandrosterone sulfate). |
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Term
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Definition
- Minoxidil (Rogaine), 20-40% see partial regrowth at 1 year for men and up to 60% for women. Hair regrowth is not permanent.
- Finasteride (Propecia): 5 alpha reductase inhibitor. Contraindicated in women of child-bearing potential. 66% of men see some regrowth.
- hairpiece/wig
- hair transplant
(side note: put all Rogaine patients on mens rogaine=stronger, use rogaine 6-8 months to see difference) |
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Term
| Caused by an obsessive urge to pull one’s own hair. Many potential psychosocial triggers – children may be having problems in school, sibling rivalry, mental retardation. Results in compulsive plucking, twisting, and rubbing which causes broken or epilated hair shafts. |
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Definition
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Term
| Trichotillomania occurs in both children and adults. The course is usually __ and resistant to treatment, especially in adults. May be a symptom of a serious underlying psychiatric disorder, more often in adults. |
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Definition
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Term
| With trichotillomania, you will see hairs in __ stages. |
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Definition
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Term
| See irregular patchy areas of alopecia, a normal scalp without inflammation or scarring, and numerous twisted and broken hairs, which have a characteristic feel of coarse stubble. |
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Definition
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Term
| Trichotillomania therapy: |
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Definition
- in children condition is usually self limiting and not associated with psychiatric illness
- in adults, refer to psychiatrist. Often treated like OCD: Clomipramine, TCAs, and SSRIs also used |
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Term
| Likely an auto-immune process that causes WELL CIRCUMSCRIBED ROUND/OVAL PATCHES OF NON-SCARRING hair loss. Incidence affects both sexes equally and is usually in early adulthood. Acute onset. 25% of patients have other autoimmune disorders like thyroid disease or vitiligo. |
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Definition
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Term
| Castration of males before puberty prevents the development of baldness. But if testosterone is administered to a pre-disposed Eunuch, he becomes bald.) |
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Definition
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Term
| alopecia areata and androgen alopecia are both: |
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Definition
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Term
| well circumbsribed round/oval patches of hair loss. Erythema and slight tenderness may be present early in course, subsequently the scalp may become slightly depressed. The peripheray of the hair loss patches are studded with EXCLAMATION POINT HAIRS. |
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Definition
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Term
| Alopcia areata effects the __, __, __, __ and other places. Fine EVENLY SPACED PITTING OF THE __ may also be seen. 1-2% will go on to lose all of scalp hair (alopecia totalis) or all of their body hair (alopecia universalis). |
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Definition
- scalp, eyebrows, eyelashes, beard
- nails |
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Term
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Definition
- TOPICAL STEROIDS
- INTRALESIONAL STEROIDS
- Immunotherapy (DCP, Squaric Acid)
- PUVA (psoralen + ultraviolet light A)
- Topical Minoxidil
- Cyclosporine
Course – Variable, unpredictable length of duration. Most patients with localized disease have spontaneous recovery, but relapses are not uncommon. The larger the area of hair loss and the longer the duration – the poorer the prognosis. |
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Term
| With alopecia areata, the larger the area of hair loss, the __ the duration. |
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Definition
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Term
| Lupus Erythematosus subdivisions: |
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Definition
- acute
- subacute
- chronic=Discoid
- Systemic |
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Term
| __ and __ lupus can often cause alopecia. |
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Definition
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Term
| SLE causes a diffuse__ telogen effluvium in 20% of patients. In addition, short broken hairs may be present particulalry in the frontal region. Other manifestations of the disease are usually present. |
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Definition
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Term
| DLE causes oval __ areas of alopecia with an active __ margin and _ __ inactive centers. Will see telangectasias, dilated skin filled follicles in the plaques. Can be found on the __, __, and __ mainly. |
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Definition
- SCARRING
- ERYTHEMATOUS MARGIN
- WHITE ATROPHIC
- scalp, ears, face |
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Term
| WILL SEE KERATIN FILLED FOLLICLES ON BALD AREAS AKA CARPET TACKING: |
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Definition
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Term
| oval, scarring areas of alopecia with an active erythematous margin and a white, atrophic, inactive center. Will see telangectasias, dilated keratin-filled follicles in the plaques. Can be found on the scalp, ears, and face predominately. |
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Definition
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Term
| DLE is confirmed by a routine __ __ for __ _. |
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Definition
| punch biopsy for H&E staining |
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Term
| For DLE what labs should be done? |
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Definition
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Term
| Goal of therapy for DLE is to prevent __ __ that results in __. Treat with __ __, __ __, and ___. |
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Definition
- follicular destruction that results in scarring
- topical steroids
- intralesional steroids
- hydroxychloroquine (plaquenil) |
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Term
| Tinea capitis is spread from human to human by __ __. It is spread from cats and dogs to humans by __ __ and __ __. |
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Definition
- M. audouinil
- T. tonsurans
- M. canis |
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Term
| Tinea capitis is almost universally restricted to __ __ __. |
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Definition
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Term
| Can appear as seborrheic-like dermatitis with minimal inflammation, patchy alopecia with broken hair shafts leaving residual black stumps (‘black dots’). Occipital lymph nodes often enlarged. Rarely, indurated boggy plaques (kerion) with pustules and crusting can result in scarring. |
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Definition
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Term
| To diagnose tinea capitis what 4 possible labs should be done ? |
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Definition
- culture of broken hairs
- KOH prep (Endothrix = Tricophyton; Ectothrix = Microsporum)
- Wood's light if suspecting Microsporum (Ectothrix), will flouresce green
- Biopsy and stain with period acid-Schiff (PAS) |
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Term
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Definition
- TOPICAL AGENST ARE NOT EFFECTIVE
- Microsize Griseofulvin (Grifulvin V) for 6-8 weeks
Terbinafine (Lamisil)
Itraconazole (Sporanox)
In addition, shampooing with 2.5% Selenium Sulfide (Selsun) twice weekly on all family members – reduces carrier state.
(side note: if endothrix> must be on systemic meds) |
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Term
Typically presents in a young girl with short blond hair who presents complaining that “her hair won’t grow.”
Hair thinning can be diffuse or patchy. |
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Definition
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Term
| How do you diagnose loose anagen syndrome? |
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Definition
- microscopically confirm with painless extraction of hair by gentle hair pulling
cause is unknown
prognosis: improves with age |
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Term
| Lichen planopilaris is a __ alopecia more common in __. |
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Definition
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Term
| Permanent loss of follicular opening and PERIFOLLICULAR ERYTHEMA AND SCALE. Can be localized or widespread. Associated with other skin surfaces/mucus membranes in 50% of cases. |
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Definition
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Term
| 4 types of scarring hair disorders: |
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Definition
- DLE
- Lichen planopilaris
- Folliculits Decalvans
- Acne Keloidalis Nuchae (AKN) |
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Term
| Dx of Lichen Planopilaris is made by: |
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Definition
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Term
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Definition
- difficult but spontaneous resolution averages after 18 montsh
- Plaquenil and oral/topical steroids |
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Term
| PERIFOLLICULAR ERYTHEMA AND SCALE: |
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Definition
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Term
| Expanding patch of SCARRING alopecia with PUSTULES AT THE PERIPHERY. Doll hair sign (multiple hairs coming out of one follicle) |
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Definition
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Term
| Folliculitis Decalvans is thought to be related to infections with __ __. Treat with __ __. |
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Definition
staph aureus
systemic antibiotics
(possible steroids and antibiotics, may have seconary infection, this is difficult to treat) |
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Term
| Doll hair sign is associated with: |
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Definition
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Term
| Acne Keloidalis Nuchae (AKN) occurs on the __ of the __ and is more common in __ pigmented skin. Early lesions are __ __ papules with a central __. Later papules may coalesce into large __ __. This is NOT caused by ingrown hairs. Treat with __ and __ __ and __/__ __. |
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Definition
- nape of the neck
- darkly pigemented skin
- dome shaped papules with a central hair
- hypertrophic scars
- intralesional/topical steroids
- oral/topical antibiotics |
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