Wednesday, January 6, 2010

Alopecia

Alopecia

Introductlon

Alopecia or hair loss is the medical description of the loss of hair from the head or body, sometimes to the extent of baldness. Unlike the common aesthetic depilation of body hair, alopecia tends to be involuntary and unwelcome, e.g., androgenic alopecia. However, it may also be caused by a psychological compulsion to pull out one's own hair (trichotillomania) or the unforeseen consequences of voluntary hairstyling routines (mechanical "traction alopecia" from excessively tight ponytails or braids, or burns to the scalp from caustic hair relaxer solutions or hot hair irons).

ETIOLOGY

In some cases, alopecia is an indication of an underlying medical concern, such as iron deficiency.

  • Androgenetic alopecia (Male pattern baldness)
  • Fungal infection such as "black dot" tinea or tinea capitis
  • Chemical breakage such as over processing, or frequent use of chemical relaxer
  • Heat damage as from repeated hot comb use
  • Chronic exposure to traction on hair shaft such as Traction alopecia
  • Compulsive hair pulling such as trichotillomania
  • Hypothyroidism
  • Iron deficiency
  • Alopecia areata
  • Telogen effluvium resulting from physical or psychological stress
  • Hereditary disorder of the hair shaft or genodermatoses
  • Secondary syphillis can cause "moth eaten hairloss"
  • Discoid lupus erythematosus or chronic cutanous lupus erythematosus
  • Lichenplanopilaris
  • Pseudopelade of Brocq
  • Tufted folliculitis
  • Dissecting cellulitis
  • Alopecia mucinosa
  • Keratosis follicularis spinulosa decalvans
  • Androgenetic alopecia (Male pattern baldness)
  • Fungal infection such as "black dot" tinea or tinea capitis
  • Chemical breakage such as over processing, or frequent use of chemical relaxer
  • Heat damage as from repeated hot comb use
  • Chronic exposure to traction on hair shaft such as Traction alopecia
  • Compulsive hair pulling such as trichotillomania
  • Hypothyroidism
  • Testosterone booster tablets.

In s Adverse effect from certain drugs such as chemotherapy Alopecia or hair loss is the medical description of the loss of hair from the head or body, sometimes to the extent of baldness. Unlike the common aesthetic depilation of body hair, alopecia tends to be involuntary and unwelcome, e.g., androgenic alopecia. However, it may also be caused by a psychological compulsion to pull out one's own hair (trichotillomania) or the unforeseen consequences of voluntary hairstyling routines mechanical "traction alopecia" from excessively tight ponytails or braids, or burns to the scalp from caustic hair relaxer solutions or hot hair irons.

ome cases, alopecia is an indication of an underlying medical concern, such as iron deficiency.

When hair loss occurs in only one section, it is known as alopecia areata. Alopecia universalis is when complete hair loss on the body occurs, similar to how hair loss associated with chemotherapy sometimes affects the entire bod.

Epidemiology

The condition affects 0.1%–0.2% of humans, occurring in both males and females, though far more females than males.

Alopecia areata occurs in people who are apparently healthy and have no skin disorder.Initial presentation most commonly occurs in the late teenage years, early childhood, or young adulthood, but can happen with people of all ages.

Types

The most common type of alopecia areata involves hair loss in one or more round spots on the scalp.

  • Hair may also be lost more diffusely over the whole scalp, in which case the condition is called diffuse alopecia areata.
  • Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere on the head.
  • Alopecia areata multilocularis refers to multiple areas of hair loss.
  • The disease may be limited only to the beard, in which case it is called Alopecia areata barbae.
  • If the patient loses all the hair on his/her scalp, the disease is then called Alopecia areata totalis.
  • If all body hair, including pubic hair, is lost, the diagnosis then becomes Alopecia areata universalis.

Alopecia areata

It is noncommunicable, or not contagious. It occurs more frequently in people who have affected family members, suggesting that heredity may be a factor,and at least one of the genes involved has been mapped to chromosome 8p21–22.In addition, it is slightly more likely to occur in people who have relatives with autoimmune diseases.

The condition is thought to be an autoimmune disorder in which the body attacks its own hair follicles and suppresses or stops hair growth.There is evidence that T cell lymphocytes cluster around these follicles, causing inflammation and subsequent hair loss. An unknown environmental trigger such as emotional stress or a pathogen is thought to combine with hereditary factors to cause the condition. There are a few recorded cases of babies being born with congenital alopecia areata; however, these are not cases of autoimmune disease because an infant is born without a fully developed immune system

First symptoms are small, soft, bald patches which can take just about any shape but are most usually round. It most often affects the scalp and beard but may occur on any hair-bearing part of the body.There may be different skin areas with hair loss and regrowth in the same body at the same time. It may also go into remission for a time, or permanently.

The area of hair loss may tingle or be very slightly painful. The hair tends to fall out over a short period of time, with the loss commonly occurring more on one side of the scalp than the other.

Another presentation of the condition are exclamation point hairs. Exclamation point hairs are hairs that become narrower along the length of the strand closer to the base, producing a characteristic "exclamation point" appearance.

One diagnostic technique applied by medical professionals is to gently tug at a handful of hair along the edge of a patch with less strength than would be required to pull out healthy hair. In healthy hair, no hair should fall out or ripped hair should be distributed evenly across the tugged portion of the scalp. In cases of alopecia areata hair will tend to pull out easier along the edge of the patch where the follicles are already being attacked by the body's immune system than away from the patch where they are still healthy. Professionals usually remind patients that the hair that is pulled out would eventually fall naturally. The test is conducted only once to identify the condition and rule out a simple localized hair loss condition.

Subterms for alopecia areata

ALOPECIA AREATA (AA) - The most commonly used term and covers all forms of the disease.
ALOPECIA PARTIALIS - The name given to specify patchy hair loss. Not often used as "alopecia areata" suffices
ALOPECIA TOTALIS (AT) - The name given to specify alopecia areata where all scalp hair is lost, but other body hair remains.
ALOPECIA UNIVERSALIS (AU) - The name given to specify alopecia areata where all scalp and body hair is lost.
ALOPECIA AREATA BARBAE - The term for an alopecia areata lesion found in the region of beard hair.
ALOPECIA AREATA OPHIASIS - The term used for an alopecia areata lesion limited to extension along the scalp margin (Occipital and temporal region - the strip of hair running from one ear around the back of the head to the other ear). Ophiasis comes from the latin "snake" due to the winding, snaking pattern the hair loss has over the back of the head. The term was originally used by Cornelius Celsus in 30AD
ALOPECIA AREATA DIFFUSA - A term occasionally used for an alopecia areata lesion of general thinning of hair on the scalp. It is usually simply called diffuse alopecia areata
RETICULAR ALOPECIA AREATA - The term used for the presence of numerous small, well defined patches of hair loss
SISAIPHO ALOPECIA AREATA - This is a new term so far only used by one clinical group in Seville, Spain (Munoz 1996). It is defined as entire loss of scalp hair except for a narrow ring of hair around the periphery.
TRIANGULAR ALOPECIA AREATA - A very rare form of alopecia areata where the hair loss lesion presents in a triangular shape
PERINAEVOID ALOPECIA AREATA - A very rare form of alopecia areata where hair is lost around nevi (moles or other skin growths)

Diagnosis


Treatment

About 50% of patients' hair will regrow in one year without any treatment. If the affected region is small, it is reasonable to observe the progression of the illness as the problem often spontaneously regresses and the hair grows back. In 90% of cases, the hair will, ultimately, grow back. In the other 10%, only some or no hair will regrow.

In cases where there is severe hair loss, there has been limited success treating alopecia areata with clobetasol or fluocinonide, steroid injections, or cream. Steroid injections are commonly used in sites where there are small areas of hair loss on the head or especially where eyebrow hair has been lost. Some other medications used are minoxidil, irritants (anthralin or topical coal tar), and topical immunotherapy cyclosporine, each of which are sometimes used in different combinations.

Oral corticosteroids decrease the hair loss, but only for the period during which they are taken, and these drugs have adverse side effects.

For small patches on the beard or head it is possible to suppress with topical tacrolimus ointments like Protopic. Symptoms may remain suppressed until aggravated by stress or other factors. Treatment with tacrolimus is recommended only for short periods of time due to adverse side effects.

Initial stages may be kept from increasing by applying topical corticosteroids. However, topical corticosteroids frequently fail to enter the skin deeply enough to affect the hair bulbs, which are the treatment target.

In terms of adapting to the disease rather than treating in an effort to cure, there are also many options available. Wigs are often used by those with Alopecia, particularly Alopecia Totalis, in which hair is entirely lost from the scalp. Wigs are available at many levels of development and technology, including wigs with suction mechanisms to keep it firmly attached to the scalp. Most of the wigs available are so well made that it is impossible without close investigation to tell whether they are a person's actual hair, or a wig.

Prognosis

In most cases that begin with a small number of patches of hair loss, hair grows back after a few months to a year. In cases with a greater number of patches, hair can either grow back or progress to alopecia totalis or, in rare cases, universalis.

Effects of alopecia areata are mainly psychological (loss of self image due to hair loss). However, patients also tend to have a slightly higher incidence of asthma, allergies, atopic dermal ailments, and even hypothyroidism. Loss of hair also means that the scalp burns more easily in the sun. Loss of nasal hair increases severity of hay fever and similar allergic conditions. Patients may also have aberrant nail formation because keratin forms both hair and nails.

Episodes of alopecia areata before puberty predispose chronic recurrence of the condition. Pitting of the fingernails can hint at a more severe or prolonged course.

Hair may grow back and then fall out again later

Psychosocial issues

Alopecia can certainly be the cause of psychological stress. Because hair loss can lead to significant appearance changes, individuals may experience social phobia, anxiety, and depression. Some psychologists have even gone as far as to describe the feelings of loss and depression felt at the onset of the disease as being similar to those felt by people afflicted with terminal illness. Sometimes people with alopecia may find it difficult to meet or date others due to social phobia but places like make it easier for people to meet others alike and also people who do not mind dating alopecia singles. In severe cases where the chance of hair regrowth is slim, individuals need to adapt to the condition, rather than look for a cure. There is currently little provision for psychological treatment for people afflicted with alopecia.

Alopecia totalis

Alopecia totalis is the loss of all head hair. Its causes are unclear, but it is an autoimmune disorder. Stress is sometimes thought to be a contributor to the hair loss caused by alopecia, however many people leading relatively stress-free lives have experienced the symptoms.

Alopecia Totalis is one of a group of three main conditions. Those three are Alopecia Areata, Alopecia Universalis, and of course Alopecia Totalis (AT). AT is an auto-immune disorder which results in the total loss of hair, but only on the scalp. It is somewhat of an intermediary condition between Alopecia Areata which is patchy scalp hair loss, and Alopecia Universalis which extends to total body hair loss. AT usually appears in two types: One being a fairly sudden and complete loss of all head hair. The other being a slower form which originates as Alopecia Areata (patchy loss) and advances to complete scalp hair loss. In this sense it is sometimes tied to Alopecia Areata but not all the time.

Most sufferers are children and young adults under the age of 40, though it can affect people of all ages. It can also affect the the nails, giving them a ridged, pitted or brittle appearance. According to statistics, 2% of men and 1% of women in western society suffer from some form of Alopecia Areata. About 2% of those have Totalis or Universalis. This means that about 1 in every 125,000 men and 1 in every 250,000 women have Alopecia Totalis or Universalis.

Causes Alopecia Totalis

This condition comes about as a result of an autoimmune disorder which causes your immune system to attack your hair follicles. In most cases there is small chance of hair recovery, however there have been cases of complete restoration as well. Consider it a genetic auto immune condition that has an unknown trigger, and which can sometimes be "un-triggered" for unknown reasons. They are still researching why hair follicles are the target of the autoimmune activities.

Treatments for Alopecia Totalis

The main treatment for Alopecia Totalis are therapies which focus on immunomodulation, such as glucocorticoid injections, anthralin, or glucocorticoids taken orally. We have heard reports from some that years of steroid therapy can put the condition into remission. Years of steroid therapy is not always enjoyable however, as there are side effects. It is important to comment that Rogaine (Minoxidil) is not effective for those with Alopecia Totalis. Some treatments which have been considered include Methotrexate, a treatment for autoimmune disorders, and corticosteroids have been proposed as treatments.

Several genes have been studied and quite a bit of research has focused on the human leukocyte antigen. Two studies demonstrated that human leukocyte antigen DQ3 (DQB1*03) was found in more than 80% of patients with Alopecia Areata, which suggests that it can be a marker for general susceptibility to Alopecia Areata. The studies also found that HLA DQ7 (DQB1*0301) and human leukocyte antigen DR4 (DRB1*0401) were found quite a bit more often in patients with Alopecia Totalis (AT) and Alopecia Universalis (AU).

Alopecia Universalis

alopecia-universalis

The most advanced form in a series of conditions all related to the same disease, alopecia universalis is characterized by total a loss of body hair.

A member of the group of hair loss conditions called alopecia areata, the only difference between alopecia universalis and its variants is the extent of hair loss.

Normally, sufferers are otherwise healthy, but are more likely than the general population to experience thyroid disease and vitiligo (patchy loss of skin color). Those with vitiligo may eventually develop AU over time. Many individuals with Alopecia Universalis are born with some hair but begin losing it very quickly. The disorder is inherited as an autosomal recessive trait. It is caused by a mutation in a gene dubbed HR in chromosome band 8p21.2 -- the human version of the gene that is responsible for hairlessness in mice.

Is the "hairless" gene only found in people with alopecia universalis? Most likely. Based on the known research, we can safely assume that only individuals with this rare and severe form of alopecia areata carry the gene. Unfortunately, there have not been enough studies to verify that this is true of all those afflicted. Aside from genetic tendencies, the contributing causes of Alopecia Universalis are not known.

As lack of body hair leaves areas like the scalp, eyes and nasal cavity particularly vulnerable, it is important that those with Alopecia Universalis take extra care to protect themselves from the sun, bacteria and other potentially harmful elements.

According to the National Alopecia Areata Foundation, fingernails and toenails can also be affected. Symptoms in the nails can range from pinprick-like indentations to severe distortion of the entire nail. Alopecia Universalis may be acute and short-lived or remain permanently. Regrowth is always a possibility, even for those with 100% hair loss over many years. However, it is not possible to predict when regrowth will occur.

Treatment

There is no standard treatment for alopecia universalis. Many treatments have been explored, including immunomodulatory agents such as imiquimod.

Alopecia Universalis may be acute and short-lived or remain permanently. Regrowth is always a possibility, even for those with 100% hair loss over many years. However, it is not possible to predict when regrowth will occur.

Noncicatricial alopecia

Noncicatricial alopecia is a nonscarring hair loss.

Causes of noncicatricial alopecia include

  • Alopecia areata
  • Anagen effluvium
  • Androgenetic alopecia
  • Dermatopathia pigmentosa reticularis
  • Telogen effluvium
  • Trichotillomania (Trichotillosis)

http://www.blackhairmedicalexpert.com/images/mild-cicatricial-alopecia.jpg

Cicatricial alopecia

Cicatricial alopecia presents clinically with the effacement/scarring of follicular orifices, always in a patchy or focal distribution.

  • Acne necrotica
  • Alopecia mucinosa
  • Atrichia with papular lesions
  • Central centrifugal cicatricial alopecia
  • Erosive pustular dermatitis of the scalp (Erosive pustular dermatosis of the scalp)
  • Folliculitis decalvans
  • Hot comb alopecia
  • Keratosis pilaris atropicans
  • Lichen planopilaris
  • Lupus erythematosus
  • Perifolliculitis capitis abscedens et suffodiens (Dissecting cellulitis of the scalp, Dissecting folliculitis, Perifolliculitis capitis abscedens et suffodiens of Hoffman)
  • Pressure alopecia
  • Pseudopelade of Brocq (Alopecia cicatrisata)
  • Sarcoidosis
  • Traction alopecia
  • Tufted folliculitis
  • Tumor alopecia

Baldness

Baldness involves the state of lacking hair where it often grows, especially on the head. The most common form of baldness is a progressive hair thinning condition called androgenic alopecia or "male pattern baldness" that occurs in adult male humans and other species. The amount and patterns of baldness can vary greatly; it ranges from male and female pattern alopecia (androgenic alopecia, also called androgenetic alopecia or alopecia androgenetica), alopecia areata, which involves the loss of some of the hair from the head, and alopecia totalis, which involves the loss of all head hair, to the most extreme form, alopecia universalis, which involves the loss of all hair from the head and the body.

Background, cause and incidence

Incidence of pattern baldness varies from population to population based on genetic background, Environmental factors do not seem to affect this type of baldness greatly. One large scale study in Maryborough, Victoria, Australia showed the prevalence of mid-frontal hair loss increases with age and affects 57% of women and 73.5% of men aged 80 and over.

According to Medem Medical Library's website, male pattern baldness affects roughly 40 million men in the United States. Approximately 25 percent of men begin balding by age 30; two-thirds begin balding by age 60. There is a 4 in 7 chance of getting the baldness gene.

Male pattern is characterized by hair receding from the lateral sides of the forehead, known as "receding hairline". Receding hairlines are usually seen in males above the ages of 20 but can be seen as early as late teens as well.

An additional bald patch may develop on top The trigger for this type of baldness (called androgenetic alopecia) is DHT, a powerful sex hormone, body, and facial hair growth promoter that can adversely affect the prostate as well as the hair located on the headmechanism by which DHT accomplishes this is not yet understood.

In genetically-prone scalps, DHT initiates a process of follicular miniaturization. Through the process of follicular miniaturization, hair shaft width is progressively decreased until scalp hair resembles fragile vellus hair or "peach fuzz" or else becomes non-existent. Onset of hair loss sometimes begins as early as end of puberty, and is mostly genetically determined. Male pattern baldness is classified on the Hamilton-Norwood scale I-VII.

It was previously believed that baldness was inherited from the maternal grandfather. While there is some basis for this belief, both parents contribute to their offspring's likelihood of hair loss. Most likely, inheritance is technically "autosomal dominant with mixed penetrance

http://www.trichologists.org.uk/images/Androgenetic-alopecia-1b.jpg

There are several other kinds of baldness:

  • Traction alopecia is most commonly found in people with ponytails or cornrows who pull on their hair with excessive force.
  • Trichotillomania is the loss of hair caused by compulsive pulling and bending of the hairs. It tends to occur more in children than in adults. In this condition the hairs are not absent from the scalp but are broken. Where they break near the scalp they cause typical, short, "exclamation mark" hairs.
  • Traumas such as chemotherapy, childbirth, major surgery, poisoning, and severe stress may cause a hair loss condition known as telogen effluvium.
  • Worrisome hair loss often follows childbirth without causing actual baldness. In this situation, the hair is actually thicker during pregnancy due to increased circulating oestrogens. After the baby is born, the oestrogen levels fall back to normal pre-pregnancy levels and the additional hair foliage drops out. A similar situation occurs in women taking the fertility-stimulating drug clomiphene.
  • Iron deficiency is a common cause of thinning of the hair, though frank baldness is not usually seen.
  • Radiation to the scalp, as happens when radiotherapy is applied to the head for the treatment of certain cancers there, can cause baldness of the irradiated areas.
  • Some mycotic infections can cause massive hair loss.
  • Alopecia areata is an autoimmune disorder also known as "spot baldness" that can result in hair loss ranging from just one location (Alopecia areata monolocularis) to every hair on the entire body (Alopecia areata universalis).
  • Localized or diffuse hair loss may also occur in cicatricial alopecia (lupus erythematosus, lichen plano pilaris, folliculitis decalvans, central centrifugal cicatricial alopecia, postmenopausal frontal fibrosing alopecia, etc.). Tumours and skin outgrowths also induce localized baldness (sebaceous nevus, basal cell carcinoma, squamous cell carcinoma).
  • Hypothyroidism can cause hair loss, typically frontal, and is particularly associated with thinning of the outer third of the eyebrows (syphilis also can cause loss of the outer third of the eyebrows)
  • Hyperthyroidism can also cause hair loss, which is parietal rather than frontal.
  • Temporary loss of hair can occur in areas where sebaceous cysts are present for considerable duration; normally one to several weeks in length.

Pathophysiology

This genetically determined disorder is progressive through the gradual conversion of terminal hairs into indeterminate hairs and finally to vellus hairs. Patients have a reduction in the terminal-to-vellus hair ratio, normally at least 2:1. Following miniaturization of the follicles, fibrous tracts remain. Patients with this disorder usually have a typical distribution of hair loss.

Preventing and reversing hair loss

Treatments for the various forms of alopecia have limited success. Some hair loss sufferers make use of clinically proven treatments such as finasteride and topically applied minoxidil (in solution) in an attempt to prevent further loss and regrow hair. As a general rule, it is easier to maintain remaining hair than it is to regrow; however, the treatments mentioned may prevent hair loss from Androgenetic alopecia, and there are new technologies in cosmetic transplant surgery and hair replacement systems that can be completely undetectable.

In the USA, there are only two drug-based treatments that have been approved by the U.S. Food and Drug Administration (FDA) and one product that has been cleared by the FDA for the treatment of androgenetic alopecia, otherwise known as male or female pattern hair loss. The two FDA approved treatments are finasteride (marketed for hair loss as Propecia) and minoxidil.

Stress reduction

Stress reduction can be helpful in slowing hair loss.

Immunosuppressants

Immunosuppressants applied to the scalp have been shown to temporarily reverse alopecia areata, though the side effects of some of these drugs make such therapy questionable.

Saw palmetto

Saw palmetto extract has been demonstrated to inhibit both isoforms of alpha-5-reductase and does not interfere with the cellular capacity to secrete PSA

Polygonum multiflorum

Polygonum multiflorum is a traditional Chinese cure for hair loss. P. multiflorum contains stilbene glycosides similar to resveratrol.

Other factors to be considered

  • Alopecia of senescence
  • Alopecia associated with virilizing disorders of women, in whom it may be seen in association with hirsutism and menstrual problems
  • Anagen effluvium after exposure to toxic chemicals, including chemotherapeutic agents
  • Alopecia associated with hypothyroidism or hyperthyroidism
  • Telogen effluvium: This condition may accelerate androgenetic alopecia, and causes, such as iron deficiency and papulosquamous diseases of the scalp, must be considered.
  • Hypertension and/or smoking: A strong association of androgenetic alopecia with hypertension was noted in a study of 250 white men aged 35-65 years. In this French study, a definite familial tendency to androgenetic alopecia was also described, but no association was noted with diabetes mellitus, hyperlipidemia, or smoking. However, a study of 740 Taiwanese men aged 40-91 years indicated an association between androgenetic alopecia and smoking. Smoking status, current amount of cigarette smoking, and smoking intensity were statistically significant in this report.

Alopecia Mucinosa

Alopecia mucinosa, often referred to as follicular mucinosis, was first reported by Pinkus in 1957.The dermatologic eruptions consist of follicular papules and/or indurated plaques that demonstrate distinct histologic changes in the hair follicles that lead to hair loss. The accumulation of mucinous material in the damaged hair follicles and sebaceous glands creates an inflammatory condition and subsequent degenerative process. The face, the neck, and the scalp are the most frequently affected sites, although lesions may appear on any part of the body.

Pathophysiology

Alopecia mucinosa is a disease process defined histopathologically by mucin deposition in hair follicles and sebaceous glands, which undergo epithelial reticular degeneration. The exact pathogenesis is unknown, although the role of circulating immune complexes and cell-mediated immunity has been considered. The 3 clinical variants of the disease consist of a primary acute disorder of young persons, a primary chronic disorder of older persons, and a secondary disorder associated with benign or malignant disease.

The primary disorder of young persons consists of focal cutaneous lesions with limited progression. Lesions are typically limited to the head, the neck, and the shoulders (see Media File 1). Most lesions spontaneously resolve between 2 months and 2 years. Pediatric cases comprise most of this type of alopecia mucinosa, with the remainder of patients being younger than 40 years. Neonatal follicular mucinosis has also been reported.

Primary chronic alopecia mucinosa of older persons affects people older than 40 years. Lesions have a widespread distribution, and they may persist or recur indefinitely. No associated disorders are identified.

The secondary alopecia mucinosa may be associated with either benign disease or malignant disease. These patients are usually aged 40-70 years, and the lesions are widespread and numerous.

Alopecia mucinosa can occur secondary to benign disease including the inflammatory conditions lupus erythematosus, lichen simplex chronicus, and angiolymphoid hyperplasia. Secondary alopecia mucinosa is also associated with malignant disease, including mycosis fungoides, Kaposi sarcoma, and Hodgkin disease; mycosis fungoides is by far the most common association.

In most patients who exhibit both alopecia mucinosa and mycosis fungoides, these conditions appear to develop concomitantly; however, the concern exists that individuals exhibiting only alopecia mucinosa may also be at risk for subsequent development of lymphoma.

Drug-induced alopecia mucinosa has been associated with the use of adalimuma and imatinib.The clinical manifestations of alopecia mucinosa are grouped follicular papules and alopecia.

  • Nodules, plaques, and patches of follicular papules may exist.
  • Occasionally, mucinous material can be expressed from active lesions, and erythema and scaling are usually present.
  • The face and the scalp are the most common sites of involvement.
  • The alopecia that develops on hair-bearing skin is of the nonscarring type
  • Usually, the alopecia is reversible unless follicular destruction has occurred due to excess mucin in the outer root sheath and sebaceous glands. In patients with permanent alopecia, the whole follicle degenerates, and the cystic cavity becomes blocked with keratinous debris. When the plugs persist, they are obvious features on healed, hairless patches of alopecia mucinosa.

Causes

Alopecia mucinosa represents various stages of follicular damage leading to hair loss. The reactive process is of unknown etiology. The role of circulating immune complexes and cell-mediated immunity has been considered.

Histologic Findings

In pattern alopecia, hairs are miniaturized. In evolving-pattern alopecia, the diameter of hair shafts varies. Fibrous tract remnants (so-called streamers) can be found below miniaturized follicles. Although androgenetic alopecia is considered a noninflammatory form of hair loss, at times, a superficial, perifollicular, inflammatory infiltrate is noted. A mildly increased telogen-to-anagen ratio is often observed.

INVESTIGATIONS

Investigations are unnecessary in most cases of alopecia areata. When the diagnosis is in doubt appropriate tests may include:

  • Fungal culture
  • Skin biopsy
  • Serology for lupus erythematosus
  • Serology for syphilis

The increased frequency of autoimmune disease in patients with alopecia areata is probably insufficient to justify routine screening

Differential diagnosis

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· Lymphomas of the Head and Neck (Otolaryngology and Facial Plastic Surgery)Otolaryngologists are frequently involved in the diagnosis of lymphoma. A quarter of all extranodal lymphomas occur in the head and neck, and 8% of ...

· Dermatologic Manifestations of Cardiac Disease (Dermatology)Cardiovascular disorders and therapies are often associated with a variety of dermatologic manifestations. Frequently, these cutaneous signs can be used in ...

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· Anxiety Disorder (Pediatrics: Developmental and Behavioral)an anxiety disorder characterized by the persistent and excessive pulling of one's own hair, resulting in noticeable hair loss. In 1889, Hallopeau, a ...

· Pyoderma Gangrenosum (Dermatology)Pyoderma gangrenosum (PG) is an uncommon ulcerative cutaneous condition of uncertain etiology. Pyoderma gangrenosum was first described in 1930. It is ...

· Polycystic Ovarian Syndrome (Pediatrics: General Medicine)In 1935, Stein and Leventhal first described the association of polycystic ovaries, amenorrhea, hirsutism, and obesity.1 However, the key features ...

· Metastatic Carcinoma of the Skin (Dermatology)are very important to recognize. Cutaneous metastasis may herald the diagnosis of internal malignancy. Early recognition can lead to accurate and ...

· Ulerythema (Dermatology)keratotic facial papules that may result in scars, atrophy, and alopecia. This disorder has been described in association with other congenital ...

· Acrodermatitis Enteropathica (Dermatology)recessive disorder characterized by periorificial and acral dermatitis, alopecia, and diarrhea. Pathophysiology The genetic mutation of SLC39A4 on 8q24.3 ...

· Breast Cancer (Oncology)frequently diagnosed life-threatening cancer in women and the leading cause of cancer death among women. Over the last two decades, breast cancer research ...

· Paraneoplastic Diseases (Dermatology)A wide range of cutaneous signs may be related to internal malignancy. Cancer may manifest in the skin as metastasis (eg, leukemia cutis, cutaneous T-cell ...


12 comments:

  1. Hi Mihul, Its good. Keep writing.

    ReplyDelete
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