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Organized by :
INTRODUCTIO
N
Clitoris
Prepuce
Labia minora
Inner surface of
labia majora
RACIAL PREVALENCE :
Whites are hairiest.
Asians are least hairy and
blacks fall in between.
TYPES OF HAIR
Morphologically :
Straight :
Spiral :
Helical :
Wavy :
Asians , whites.
Blacks, whites.
Whites.
Whites.
Adult hair Vellus hair : fine hairs cover most of the body
of youngsters and adults.
Terminal hair: long, coarse, pigmented hairs with
larger diameters.
NUMBER OF HAIRS
Scalp : about 1,00,000 hairs.
Face : about 600 hairs /cm2.
Rest of the body : about 60 hairs/cm2.
FUNCTIONS
1. Protects body surface from external injury.
2. Helps in sensory function.
3. Psycho social importance.
4. Forensic importance.
i. Identification of race, sex, age and religion.
ii. Cause of death- can be determined.
iii. Time of death- can be determined.
5. Assist thermo- regulation: mainly in lower animals.
DEVELOPMENT OF HAIR
Ectodermal origin1.
2.
of gestation.
Mesodermal origin :
HAIR EMBRYOLOGY
HAIR CYCLE
It is believed that each hair follicle goes
through 10-20 hair cycle in a life time.
There are four phases1. Anagen : growing phase.
2. Catagen: involuting phase.
3. Telogen : resting phase.
4. Exogen : hair shedding phase.
keratinocytes
abruptly
cease
But new hair does not push out the hair from
the previous cycle.
PIGMENTATION OF HAIR
Hair color is determined by melanocytes.
ALOPECIA
CLASSIFICATION OF ALOPECIA
1. FOCAL HAIR LOSS
Non-Scarring:
SCARRING ALOPECIA
A. Lymphocytic-
Abnormality of cycling
i. Alopecia areata.
ii. Telogen effluvium.
iii. Anagen effluvium.
iv. Loose anagen syndrome.
B.
ALOPECIA AREATA
Definition:
Rapid and complete loss of hair in one or
most often several round or oval patches,
usually on the scalp, bearded area,
eyebrows, eye lashes and less commonly on
other hairy areas of the body.
ALOPECIA AREATA
ALOPECIA AREATA
ALOPECIA AREATA(Contd.)
Epidemiology:
Approximately 1.7% of the population will
experience an episode of alopecia aerata
during their life time.
ETIOPATHOGENESIS
Trauma
Neurogenic
Inflammation
Infections
agents
Release of cytokines
Aberrant expression of MHC (due to
failure of repression)
Aberrant expression of adhesion
molecules
CLINICAL FEATURE
Rapid and complete loss of hair in one
or several patches.
Site Scalp, bearded area, eyebrows,
eye lashes and less commonly other
areas of body.
Size Patches of 1-5 cm in diameter.
ALOPECIA UNIVERSALIS
ALOPECIA TOTALIS
ASSOCIATED DISEASE
HISTOLOGY
Peribulbar, Perivascular and outerroot sheath infiltration with T-cells and
macrophages.
The follicular size are diminished and
identified in more superficial dermis.
DIFFERENTIAL DIAGNOSIS
1. Tinea capitis.
2. Trichotilomania.
3. Secondary syphilis
4. Congenital triangular alopecia.
5. Alopecia neoplastica.
6. Early lupus erythematosus.
TREATMENT
Spontaneous recovery is extremely common
for patchy alopecia areata.
For localized patchy alopecia areata
TREATMENT (CONTD.)
- High potent topical steroid used as first
line therapy.
- Intralesional steroid given at 4-6 weeks
interval.
- Systemic steroid (Short course, <8 weeks)
alone or in conjunction with topical steroid.
TREATMENT (CONTD.)
If lack of response after several months therapy Topical 1% Anthralin cream - applied for 15-20
minutes and then shampooed off the treated side.
5% topical minoxidil as a single agent or as an
adjuvant with topical Anthralin.
PUVA.
TREATMENT (CONTD.)
Contact sensitizer
- Squaric acid dibutyle ester,
- Diphencyprone,
- Dinitrochlorobenzene.
Psychological support.
In extensive scalp hair loss- cosmetically
expectable alternatives.
PROGNOSIS
Poor prognostic marker-
Extensive involvement.
Ophiasis.
ANDROGENETIC ALOPICIA
ANDROGENETIC ALOPICIA
ANDROGENETIC ALOPECIA
Synonyms :
sites :
Etiopathogenesis:
ETIOPATHOGENESIS (Contd.)
Testesterone
5 R
Dihydrotesterone.
ANDROGEN
Androgen - androgen receptor complex in cytoplasm
transformation of receptor to expose DNA binding domain
ETIOPATHOGENESIS (Contd.)
EFFECTS
- Shortening of anagen and
lengthening of telogen
- Follicle become short and sclerosis of
dermis and miniaturization or reduction
of hair present.
CLINICAL FEATURE
ETIOLOGY (CONTD.)
Adrenal cause
- Congenital adrenal hyperplasia (androgenital
syndrome) due to deficiency of
21 hydroxylase (most common)
11- hygroxylase.
3- hydroxysteroid dehydrogenase.
- Tumor
Adrenal adenoma
Carcinoma.
CLINICAL FEATURE
Pattern of hair loss :
Christmas
progressive
tree
pattern-
reduction
of
diffuse
and
density
and
TREATMENT
1. Topical Minoxidil (2% & 5%)
TREATMENT (CONTD.)
3. In women spironolactone ( >100
mg daily).
- Flutamide (250-500
mg bid or tid).
- Cyproterone actate.
4. Surgical treatment- Micrograft &
minigraft from non-androgen
dependent site (occiput).
TELOGEN EFFLUVIUM
It is a reaction pattern to a variety of
physical and mental stressors represents
a precipitous shift of a percentage of
anagen hairs to telogen.
(Contd.)
Drugs
Angiotensin-converting enzyme inhibitors.
Anticoagulants.
Antimitotic agents.
Benzimidazoles.
Beta blockers.
Interferon
Lithium
Oral contraceptives.
Retinoids.
Vitamin A excess.
Physical stress
-
Anemia
Surgery.
Systemic illness.
Psychological stress
II.
Pathology
1. > 12% to 15% of terminal follicles are in
telogen.
2. Follicle itself is not diseased.
3. No inflammation or dystrophic changes.
CLINICAL PRESENTATION
TREATMENT
No specific therapy.
In majority cases hair will grow spontaneously
within few month after removing inciting cause.
In some patients with chronic telogen effluvium- 5% minoxidil solution, 70% success in
man .
- For Premenopausal women, 5% minoxidil
solution + cyproterone acitate 50 mg from
day 5 to 15 of menstrual cycle taken
together with ethynnyl estradiol (0.035
mg/day).
TREATMENT (CONTD.)
For post menopausal women,
- Cyproterone acetate 50 mg/day.
- Spironolactone (50- 100 mg/day) or flutamide
125- 250 mg/ day alternative to cyproterone
acetate.
TRICHTILLOMANIA
TRICHOTILOMANIA
TRICHOTILOMANIA IN A WOMEN
ALOPECIA SYPHILITICA
Typical motheaten appeorance on the occipital
scalp or generalized thinning of hairs or both.
Eyebrows, eyelash and body hairs also
involved.
It may be one or sole cutaneus manifestation of
secondary syphilis.
Treatment of syphilis may reverse the hair loss.