Alopecia CS-OSPE

Alopecia CS-OSPE

Androgenic alopecia

Diagnosis:

• Androgenic alopecia.

Causes (Differential Diagnosis/Associated Conditions):

• Neoplastic disorders: Basal Cell Carcinoma.
• Trauma: 2nd & 3rd degree burns.
• Lichen planus: It’s a common cause of scarring hair loss.
• Discoid lupus erythematosus.

Treatment: Topical:

• Minoxidil:
  • 2% for females.
  • 5% for males.
  • Used twice per day.
  • Note: For females, it shouldn’t be used during pregnancy. Systemic:
• Finasteride:
  • Side effects:
    • In males: feminization.
    • In females: contraindicated in pregnant women carrying a male infant (it can affect the gonads of the infant).
• Spironolactone: Has an anti-adrenergic effect. Surgical:
• Hair transplantation.

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Z

Alopecia Areata

A 32 y/o male presented with 4 months duration non-pruritic on-scaly scalp lesion. Sudden hair loss (localized or generalized), Well demarcated, Exclamation point? Normal scalp, Nail: pitting, ridges. (Grey hair present usually) Diagnosis: Alopecia Areata

Characteristic Features/Clinical Presentation:

• Rapid and complete loss of hair in one or several patches, Patches of 1-5 cm in diameter its well demarcated.
• The characteristic feature or the primary lesion is Exclamation point hairs.
• Nail changes: pitting, ridges.

Differential Diagnosis:

• Tinea capitis.
• Trichotillomania.
• Secondary syphilis.

Associated diseases/Higher incidence/Cause/Predisposing factors:

• Atopic dermatitis.
• Down syndrome.
• Lichen planus.
• SLE.
• Myasthenia Gravis.
• Hashimoto Thyroiditis.
• Addison’s disease.
• Vitiligo.
• Autoimmune conditions (e.g., DM).
• Psychological stress can be a predisposing factor.
• Genetic background, as 30% have a positive family history.

Types:

1. Localized partial
2. Localized extensive
3. Alopecia ophiasis
4. Alopecia totalis
5. Alopecia universalis

Bad/Poor prognostic factors?Z

• Young age (Old age is NOT a poor prognosis factor)
• Atopy
• Alopecia totalis, universalis, ophiasis (Extra scalp/ outside scalp involvement / Multiple lesions) (This patient has poor prognosis = multiple lesions)
• Nail changes: pitting or ridges

Management/Treatment:

• Full history
• Examination
• Investigation (Histopathology = swarm bees)
• Education
• Observation
• Intralesional Corticosteroids
• Skin Sensitizers: Anthralin, Diphencyclopropenone (DPCP)
• Hair Transplant
• Topical steroids
• Systemic Steroids
• Cytotoxic Rx
• Phototherapy: Narrow band – UVB – PUVA
• Minoxidil

Other indications for intralesional steroids?

• Keloid
• Vitiligo
• Acne Vulgaris
• Infantile hemangioma
• Alopecia

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Scarring alopecia

What is the diagnosis?

• Scarring alopecia.

What are the causes?

• Neoplastic disorders: Basal Cell Carcinoma.
• Trauma: 2nd & 3rd degree burns.
• Lichen planus: It’s a common cause of scarring hair loss.
• Discoid lupus erythromatosus.

What is the treatment?

• Topical:
  • Minoxidil:
    • 2% for females and 5% for males.
    • Used twice per day.
    • For females, it shouldn’t be used during pregnancy.
• Systemic:
  • Fenestride:
    • Side effects:
      • In males: Feminization.
      • In females: If pregnant with a male infant, it may affect the gonads of the infant.
  • Spironolactone: Has an anti-adrenergic effect.
• Hair transplantation.