Hair disorders
•
Commonest
cause of hair loss.
•
An
autoimmune disease.
•
Hairless,
smooth areas are most often on the scalp. At the margin short remnants of broken
hairs are visible (‘exclamation marks’).
•
All of
the scalp (alopecia totalis) or the whole body (alopecia universalis) may be
involved.
•
Hair
typically regrows after 6–12mths, but may be recurrent.
•
The
larger the area of hair loss, the poorer the prognosis.
May be
unintentional (e.g. chronic hair twisting due to ponytail or rubbing of occiput
in babies) or intentional (trichotillomania) due to hair pulling, twisting, or
cutting as part of habit or s to
anxiety, chronic social depri-vation, or psychological disorder.
Characteristically, there is an irregular margin, as well as bizarre patterns
without complete hair loss, and broken hairs of different length. Hair re-grows
once behaviour is modified.
Tinea capitus,
ringworm.
Scarring
alopecia Commonest cause is
aplasia cutis. Circumscribed areas of the skin are absent, usually on scalp,
which presents at birth with raw, red ulcer that heals with scarring and later
absent hair growth. There is a significant incidence of other abnormalities
(e.g. trisomies). Irreversible absent local-ized hair growth will also follow
other causes of trauma (e.g. burns, skin disease, trauma).
A rare autosomal recessive condition.
Hair is present in the newborn pe-riod, but total hair loss occurs over the
next few months and does not regrow. May be associated with other anomalies.
Hair loss can be s to hypothyroidism, diabetes
mellitus, severe systemic disease,
iron or zinc deficiency, chemotherapy.
•
History: include general health, recent
illnesses, drug history, family history
of alopecia, age of onset.
•
Examination: pattern of hair loss; scalp and
general examination.
•
Investigations: hair M,C&S; Wood’s light
(tinea capitus); scalp biopsy.
•
Treat
any underlying condition.
•
Wigs
may be helpful.
Topical steroids may be helpful
for alopecia areata.
Defined as hair growth in areas
not normally hairy in either sex.
•
Racial.
•
Familial.
•
Certain
rare syndromes (e.g. Cornelia De Lange syndrome, mucopolysaccharidosis).
•
Drugs
(e.g. diazoxide, ciclosporin, minoxidil).
•
Anorexia
nervosa.
·Protein-energy malnutrition.
•
Persistence
of foetal lanugo hair at birth.
Localized hypertrichosis may be
associated with pigmented naevi, spina bifida occulta, inflammatory skin
diseases, or topical steroids.
If required remove or treat
underlying cause if possible; hair removal
using depilatory creams or waxing.
Male pattern of hair growth in
females.
•
Racial.
•
Familial.
·Androgen excess (adrenal
hypoplasia or tumour, Cushing’s disease, polycystic ovary syndrome).
•
Turner’s
syndrome.
•
Drugs
(e.g. anticonvulsants, progesterones, anabolic steroids).
If there is any suggestion that
not racial or familial (e.g. virilization evident).
•
FBC.
•
Plasma
free testosterone.
•
Plasma
17-OH progesterone.
•
Serum
cortisol.
•
Urine
steroid profile.
•
Skull
X-ray to detect possible pituitary tumour.
Treat any underlying disease;
reassure if racial or familial; hair removal
using depilatory creams or waxing.
All diseases are rare and include:
•
Menkes kinky hair disease: wiry wool hair;
•
Monilethrix: a rare autosomal dominant
condition that causes brittle hair
that fails to grow and breaks at 1–2cm;
•
Pili torti: hair repeatedly twists over 180*, leading to brittle hair that ‘flickers’ under direct light;
Woolly
hair syndrome: wiry
woolly Afro-Caribbean-like hair in Caucasians.
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