Mod 5 week 2 Hair

Inflammation at the level of the arrector pili muscle results in....
Scarring alopecia
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Phases of hair growth, %s
Anagen 90% active growth, catagen (growth stops, follicle shortens -> club hair)), telogen (resting and shedding) 5-8%
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How do androgens affect the hair cycle?
Can cause follicles producing vellus hair to change to terminal hair production. Can prolong anagen phase of body hairs and shorten it in scalp hairs.
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How many hairs are shed per day, more when?
100, after washing or at end of summer
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What does an anagen hair look like under microscopy. Telogen
As if wearing a sock - pigmentation. Club hair - depigmented 'club' = hair bulb, esily palpable
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How does % of hairs in telogen effluvium change?
5-10% -> 30-40
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Causes of sudden hair loss
TE, alopecia areata
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Causes of gradual thinning
Male pattern hair loss, CCCA, some forms of telogen effluvium.
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When do you get sore/stinging/itching/burning scalp with hair loss?
Scarring alopecias.
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Describe pull test
30 hairs bunched up and gently tugged -> look at any hairs extracted for club end (telogen). Over 5 = postive (but can get false ve if pts have washed their hair that day)
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How do follicles differ in scarring vs non scarring alopecias?
Scarring - follicle destroyed - absence/reduction in follicular orifices. Non-scarring - preservation of follicular orifice
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6 types of non scarring alopecia
Alopecia areata. Androgenetic alopecia. Telogen effluvium. Tinea capitis. Anagen effluvium. Traumatic alopecia.
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Alopecia areata what % of pts have +ve fhx autoimmune disease
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Also associated with
Atopy - 10% of patients. poorer prognosis.
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What features confer poorer outcome? 7
Atopy. Pitting. Pre-puberty. PERSONAL hx other autoimmune conditions e.g. thyroid. Ophiasis - occurs at occipital scalp margin (band like hair loss). Long duration. More extensive disease.
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Alopecia areata O/E
Circumscribed patch of non-scarring alopecia. Exclamation mark hairs - short pigmented club hairs with thickened, frayed ends. Found at periphery of patch and are marker for activity. Pull test in this area +ve - dystrophic anagen hairs.Scalp shiny
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Do pts get any sx?
May get buzzing/tingling before onset
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What is alopecia totalis, universalis
Complete loss of scalp hair. Body hair
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follicle surrounded by dense lymphocytic infiltrate - swarm of bees
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Variable. 50% with patchy disease get remission. Single patch regrows within few months. White initially in centre of patch - good prognostic sign. White hairs less affected and dark hairs more so -> 'going white overnight'
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Are nails affected wtih AA? How?
Can be. Regular fine pitting. Can get severe dystrophy with extensive AA.
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Rx AA children <5
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Rx AA 5-10 years old
Minoxidil 5% BD + potent topical steroid e.g. mometasone (top steroids penetrate better in kids)
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Rx AA >10
<50% involved: Dermovate (up to 8 weeks) + minoxidil BD. Consider IL steroids 6 weekly into subcutis - useful for beard/eyebrows. >50% - wigs
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Risks of IL steroid injection (tramcinolone)
Pain , atrophy, hypopigmentation, failure
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Downsides of topical minoxidil. how long to work?
Not available on FP10. Hair growth tends to fall out on cessation of therapy. Can get effluvium 4 weeks into Rx (short lasting). 9-12 mo before noticeable improvement. Local scalp irritation with liquid, but foam ok. increased facial hair risk
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What can you use instead of topical steroids
Calcineurin inh - off licence. No hypopigmentation. No evidence base.
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Role of systemic Rx - which
Extensive disease. Steroids. Immunosuppressants e.g. Ciclosporin. Hard to stop as relapses on stopping. NOT recommended by BAD.
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Wig allowance on NHS. What do British Red Cross offer? What to advise pts with no eyebrows?
2 acrylic wigs per year via consultant dermatologist. Advice about cosmetics/semi perm make up. Glasses - keep dust/grit out of eyes.
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Male androgenetic alopecia/MPB - inheritance
From either parents. AD or polygenetic
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Hallmark of androgenetic alopecia. What hormone implicated?
Gradual miniaturisation of terminal hairs into small vellus-like hairs (seen via dermatoscope). DHT
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Androgenetic alopecia what scale used to classify?
Hamilton scale
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Rx androgenetic alopecia
Topical minoxidil. 5 alpha reductase inhibitors - finasteride, dutasteride. Surgical - hair transplant or scalp reduction
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Regime for minoxidil
5% foam to dry hair at night to affected area. Get it good keep it good - use OD for 1 year, then 3xweek
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What % of pts does finasteride work in? Does it slow down loss or promote regrowth?
65-70%. Both
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Concerns about finasteride. Checks?
Increase in risk of high grade prostate ca. Actually current evidence suggests it lowers incidence of prostate ca. in >45s check PSA at baseline and annually thereafter. 2% get erectile issues or loss of libido, usually reversible on cessation
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Female pattern hair loss - CFs, initial presentation, how different to male pattern?
Gradual thinning, need to tie band more times for ponytail. Widening of parting with frontal accentuation - xmas tree pattern over vertex. Good preservation of follicle density over occiput. Unlike men, frontal area not initially involved
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Ludwig scale
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Female pattern hair loss is hair pull positive?
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Histologically? Androgen role
Miniaturisation as in male pattern. Less clear cut than men and response to anti-androgen Rx less satisfactory. Can have normal androgens. If raised, then 85% will be due to PCOS
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Difficult. Minoxidil foam at night. Scalp coverage cosmetics e.g. Nanogen Nanofibers, DermMarch powder. Oral antiandrogens - Yasmin, Dianette, spironolactone, cyproterone acetate day 1/10 cycle. Finasteride off licence? Transplant
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What is it important to check for?
Low ferritin or thyroid disease as a co factors.
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Is transplant as effective as in men? Risk?
No, less satisfactory donor site. Risk of Hair Shock phenomenon post-op
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Telogen effluvium causes 8
1. illness/malnutrition/low protein 2. Fe def, low zinc ?low vit D 3. Thyroid/pituitary/parathyroid 4. Post-partum 5. Drugs 6. Acute lupus 7. Stress 8. Dermatitis of scalp - Seb derm/contact dermatitis - always treat dermatitis
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How long after stressful event/illness/birth
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Is it important to treat coexistent seb derm of scalp with TE or pattern loss? How??
Yes. Nightly potent topical steroid 1mo, then twice monthly + ketoconazole twice weekly for 1 mo then twice monthly
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O/E. hair pull?
Reduced density of hair at temples. Short, upright regrowing hairs on dermoscopy. +ve - >6 telogen hairs
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Other Ix
Bloods - ferritin, Hb, vit D, ANA, thyroid. may need biopsy to distinguish from diffuse alopecia areata.
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prognosis, Rx
Normal head of hair within 1 year. Can use topical minoxidil to tide them over. Treat concomitant seb derm
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Rx tinea capitis
Griseofulvin or terbinafine 4wk. Treat pt and whole family with Nizoral.
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Traumatic alopecia - who
Trichotillosis - can occur in kids as a habit, or young women with psychological disturbance. Cosmetic alopecia - hairdressing habits
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Trichotillosis - CFs 3. Does it scar
Preservation of hairs at periphery, presence of localised/unilateral problem, presence of broken/plucked hairs within the area of alopecia. Rarely
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Traction alopecia CFs
Usually affects frontal and parietal regions e.g. due to corn row braiding. 'Fringe sign' - some hair is retained along the frontal and temporal rim of hairline
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Types of scarring alopecia? 6
1. Lichen planopilaris, frontal fibrosing alopecia FFA 2. DLE 3. Folliculitis decalvans 4. Dissecting cellulitis of scalp 5. Central centrifugal cicatrial alopecia CCCA 6. Secondary scarring alopecia e.g. DXT,skin cancer,sarcoid, trichotil
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Lichen planopilaris - appearance of scalp, sx, onset
Scalp tender with erythema and perifollicular scaling. Rapid/explosive.
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What is FFA. What to look for to help dx?
Form of LP, middle aged women - frontal margin recedes in hairband like fashion. Can get eyebrow loss and facial papules. Look for stray marooned hairs that appear to be growing alone in front of the receded hairline
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Ix LP. How do plaques differ to DLE?
Scalp biopsy for H&E and IF. Activity around PERIPHERY of scarred area (cf discoid - centre)
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Trickly. Potent topical steroids + doxy 100mg OD can be tried in GP - may not work. Systemic immunosuppressants.
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IL triamcinolone to frontal margin every 4mo + doxy +/- hydroxychloroquine
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DLE appearance
Discrete or confluent plaques with follicular plugging and scaling. Post-infl hypo/hyperpig.
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Biopsy for H&E and IF
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Potent topical steroids, hydroxychloroquine
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What is psuedopelade of Brocq
end stage scarring alopecia (due to either DLE or LPP) -> burned out inactive scarring, looks like 'footprints in the snow'
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What is folliculitis decalvans? M/F? Rx?
Atrophic areas of alopecia with pustules at the edges, can progress to severe scarring. Both. Oral and topical abx, refer
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Dissecting cellulitis of scalp - who. Cause?
Afro-Caribbean males. Hyperkeratosis, not infection
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Firm fluctuant nodules and pustules on scalp -> coalesce to form extensive boggy areas. Scarring hypertrophic or keloidal.
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Hard. Topical abx, IL steroids, oral abx, dapsone, isotretinoin, biologics
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Central centrifugal cicatrial alopecia CCCA - who? cause? Appearance
Middle aged Afro-Caribean hair, hx chemical straighteners. Starts in middle and spreads out, relative preservation around occiput and parietal areas
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Tetracycline + superpotent topical steroids. minoxidil. Treat concomitant seb derm
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Why would patient have had radiotherapy to scalp in the past (pre-1950s)?
To treat ringworm
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What is erosive pustular dermatosis of scalp? Who? Rx?
Elderly men and women. Crusting pustules and erosions on sun damaged scalp. V responsive to Dermovate. Can also use permanganate soaks and oral abx.
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Pityriasis capitis (dandruff) which yeast. Relationship to seb derm?
Pityrosporum ovale. Seb derm is extreme end of spectrum
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Anti-yeast shampoo e.g. Nizoral. Shampoo with coal tar or salicylic. CoCois in severe cases.
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What is pityriasis amiantacea. Rx
Silvery white bran like scales adherent to scalp and running up hair shafts. Commonly part of seb derm but can represent psoriasis. Coal tar or keratolytic Rx
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What is hirsuitism. Cause
Excessive growth of terminal hair in a typically male pattern distribution. Usually due to raised circulating androgens, mainly PCOS
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Rarer causes of hirsuitism - OVARIAN
OVARIAN - androgen-secreting tumours, ovarian hyperthecosis (post-menopasual women with hx PCOS - continued LH stimulation of ovarian androgen production in absence of conversion to oestrogens)
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ADRENAL causes, PITUITARY. Idiopathic (rare), Iatrogenic
CAH (classic and non classic - presents in adolescence with identical sx to PCOS), Cushings. PIT - Cushings, acromegaly, hyperprolactinaemia. Steroids - anabolic/GC
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Do phenytoin and minoxidil cause hirsuitism?
No, hypertrichosis
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Ix hirsuitism? Timing
0900 during follicular phase. Testo, SHBG, LH, FSH, prolactin, 17-OHP, TFT. Pelvic USS
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Endocrine therapies for hirsuitism?
COCP, GnRH analogues, cyproterone acetate (alone or as Dianette), spironolactone, finasteride
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Topical Rx?
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Is metformin effective for idiopathic hirsuitism
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Other cards in this set

Card 2


Phases of hair growth, %s


Anagen 90% active growth, catagen (growth stops, follicle shortens -> club hair)), telogen (resting and shedding) 5-8%

Card 3


How do androgens affect the hair cycle?


Preview of the front of card 3

Card 4


How many hairs are shed per day, more when?


Preview of the front of card 4

Card 5


What does an anagen hair look like under microscopy. Telogen


Preview of the front of card 5
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Ellenor Jacobson


Very helpful, it's exactly what i was searching for

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