DERMATOLOGY SERIES | SKIN DISEASE AWARENESS | APPROACH TO HAIR LOSS | DR. SUCHANA MARAHATTA | BPKIHS

DERMATOLOGY SERIES | SKIN DISEASE AWARENESS | APPROACH TO HAIR LOSS | DR. SUCHANA MARAHATTA | BPKIHS

***VERBAL CONSENT WAS TAKEN FROM THE PATIENT***

A video by:
Dr. Bharat Kc (MBBS, B. P. Koirala Institute of Health Sciences, Dharan, Nepal)

APPROACH TO HAIR LOSS:
D/D
ALOPECIA AREATA
TELOGEN EFFLUVIUM
FEMALE PATTERN HAIR LOSS (FPHL)

ALOPECIA AREATA
Alopecia areata is a recurrent nonscarring type of hair loss that can affect any hair-bearing area and can manifest in many different patterns. Although it is a benign condition and most patients are asymptomatic, it can cause emotional and psychosocial distress.
Signs and symptoms
Alopecia areata most often is asymptomatic, but some patients (14%) experience a burning sensation or pruritus in the affected area. The condition usually is localized when it first appears, as follows:
Single patch – 80%
Two patches – 2.5%
Multiple patches – 7.7%
No correlation exists between the number of patches at onset and subsequent severity.
Alopecia areata can affect any hair-bearing area, and more than one area can be affected at once. Frequency of involvement at particular sites is as follows:
Scalp – 66.8-95%
Beard – 28% of males
Eyebrows – 3.8%
Extremities – 1.3%

Associated conditions may include the following
Atopic dermatitis
Vitiligo
Thyroid disease
Collagen-vascular diseases
Down syndrome
Psychiatric disorders – Anxiety, personality disorders, depression, and paranoid disorders
Stressful life events in the 6 months before onset
Alopecia areata can be classified according to its pattern, as follows:
Reticular – Hair loss is more extensive and the patches coalesce
Ophiasis – Hair loss is localized to the sides and lower back of the scalp
Sisaipho (ophiasis spelled backwards) – Hair loss spares the sides and back of the head
Alopecia totalis – 100% hair loss on the scalp
Alopecia universalis – Complete loss of hair on all hair-bearing areas

Diagnosis
Diagnosis usually can be made on clinical grounds. A scalp biopsy seldom is needed, but it can be helpful when the clinical diagnosis is less certain.

Management
Treatment is not mandatory, because the condition is benign, and spontaneous remissions and recurrences are common. Treatment can be topical or systemic.

Corticosteroids

Intralesional corticosteroid therapy is usually recommended for alopecia areata with less than 50% involvement. Administration is as follows:

Injections are administered intradermally using a 3-mL syringe and a 30-gauge needle

Triamcinolone acetonide (Kenalog) is used most commonly; concentrations vary from 2.5-10 mg/mL

The lowest concentration is used on the face

A concentration of 5 mg/mL is usually sufficient on the scalp

Less than 0.1 mL is injected per site, and injections are spread out to cover the affected areas (approximately 1 cm between injection sites)

Injections are administered every 4-6 weeks

Topical corticosteroid therapy can be useful, especially in children who cannot tolerate injections. It is administered as follows:

Fluocinolone acetonide cream 0.2% (Synalar HP) twice daily or betamethasone dipropionate cream 0.05% (Diprosone) has been used

For refractory alopecia totalis or alopecia universalis, 2.5 g of clobetasol propionate under occlusion with a plastic film 6 days/wk for 6 months helped a minority of patients

Treatment must be continued for a minimum of 3 months before regrowth can be expected, and maintenance therapy often is necessary

Systemic corticosteroids (ie, prednisone) are not an agent of choice for alopecia areata because of the adverse effects associated with both short- and long-term treatment. Some patients may experience initial benefit, but the dose needed to maintain cosmetic growth is usually so high that adverse effects are inevitable, and most patients relapse after discontinuation of therapy.

TELOGEN EFFLUVIUM
Telogen effluvium is a form of nonscarring alopecia characterized by diffuse hair shedding, often with an acute onset. A chronic form with a more insidious onset and a longer duration also exists. Telogen effluvium is a reactive process caused by a metabolic or hormonal stress or by medications. Generally, recovery is spontaneous and occurs within 6 months, unless a background of pattern alopecia is present.
Prognosis
Mortality has not been reported. Morbidity is limited to mild cosmetic changes. However, telogen effluvium can have substantial impact on those affected. Prognosis is good for recovery of normal hair density in acute telogen effluvium. A good cosmetic outcome can be expected in chronic telogen effluvium, even if hair shedding continues.

REFERENCE: MEDSCAPE

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