ALOPECIA

Question 1

complete loss of scalp hair

Answer 1

Alopecia totalis

Question 2

loss of all body hair

Answer 2

Alopecia universalis

Question 3

alopecia associations?

Answer 3

Atopic dermatitis, Downs syndrome, Lichen Planus,

SLE, Thyroiditis, Myasthenia Gravis, and Vitiligo

Question 4

what is this?

Rapid and complete loss of hair in one or several areas (scalp,
bearded area, eyebrows, eyelashes)

Etiology

• Autoimmune disease targeting follicular cells
• Hereditary: 25% with +FHx, HLA associations: DR4, DR11, DQ7

Pathology: lymphocytic peribulbar infiltrate around anagen hairs

Answer 4

Alopecia Areata

Question 5

what is this?

• Early and excessive loss of normal club hairs from normal resting follicles in the scalp
• Surgery, parturition, fever, drugs, eating disorder protein/nutrient deprivation
• Hair pull test results in more than 4-6 club hairs.

Answer 5

Telogen Effluvium

Question 6

what is this?

• Loss of anagen hairs usually secondary to chemotherapeutic agents.
• Telogen and catagen hairs are in a resting state and are not
affected.
• Most apparent clinically in 1-2 months after administration
of chemotherapy.
• Resolves in 2-4 weeks after discontinuation of drug but hair
grows back slowly.

Answer 6

Anagen Effluvium

Question 7

what is this?

• Manifests in 20s and 30s with gradual hair loss from the vertex
and frontotemporal regions
• Response of hair follicle to DHT which results in gradual
miniaturization of hair follicles

Answer 7

Male-Pattern Baldness

Question 8

what is this?

• Diffuse hair loss greatest at the crown, sparing the frontal hairline, temporal recession
• Genetic predisposition
• Work up: polycystic ovarian syndrome, free testosterone, ferritin, thyroid function
tests

Answer 8

Female Pattern Baldness

Question 9

what is this?

• Compulsive practice of plucking hair usually from the scalp, eyebrows, or eyelashes
• Clinically with patchy alopecia that contain hairs of varying length and the scalp has a rough texture resulting from the short remnants of broken-off hairs.
• Most common in girls under age 10
• Worse with stress, associated with OCD

Answer 9

Trichotillomania

Question 10

what is this?

Erythema, atrophy, follicular plugging, mottled hyper- and
hypopigmentation

Answer 10

Discoid Lupus Erythematosus

Question 11

what is this?

• Perifollicular erythema, ivory white irregular patches
• Frontal fibrosing alopecia

Answer 11

Lichen Planopilaris

Question 12

what is this?

• Hot comb alopecia, follicular degeneration
syndrome
• Chemical processing, heat, traction, trauma
• May have clinical overlapping features with
folliculitis decalvans

Answer 12

Central Centrifugal Cicatricial

Alopecia

Question 13

what is this?

• Neutrophilic scarring alopecia, pustules are the primary
lesions
• S. aureus induces abnormal suppurative immune
response.
• Recurs after antibiotics are discontinued

Answer 13

Folliculitis Decalvans

Question 14

what is this?

• Part of the follicular occlusion tetrad:
-acne conglobata
-hidradenitis suppurativa
-pilonidal cysts
• Sites of predilection: Vertex and occiput
• TCN, retinoids, intralesional steroids

Answer 14

Dissecting Cellulitis

Question 15

what is this?

• Prolonged tension on the hair
• Tightly braided, ponytail, pulling the hair to straighten
it, habit of twisting the hairs with the fingers.
• Hemorrhage and inflammation lead to scarring and
permanent loss

Answer 15

Traction Alopecia

Question 16

other causes of alopecia?

Answer 16

sarcoidosis
pressure alopecia
alopecia neoplastica
syphilis

Question 17

what is this?

• Malformation of hair characterized by twisting of the hair shaft on its own axis leaving the hairs brittle and easily
broken.
• Classic type is AD and presents in childhood and is not
associated with other disorders.

Answer 17

Pili Torti

Question 18

what is this?

• X-linked recessive, “brittle, steel wool” hair
• Drowsiness, lethargy, convulsive seizures, and severe neurologic deterioration with periodic hypothermia
• Diffuse cutaneous hypopigmentation, doughy skin, and an exaggerated cupid bow
• Defective MNK gene (ATP7A) which encodes a copper-transporting ATPase, which is not expressed in the liver (unlike ATP7B, the mutated gene in Wilson’s)
• Blocks the export of dietary copper from the GI tract which results in a copper deficiency
• Low serum copper and cerruloplasmin

Answer 18

Menkes Kinky Hair Syndrome

Question 19

what is this?

• Pili trianguli et canaliculi: Spun-glass hair
• Triangular hair shaft, central longitudinal groove
• Clinically the defect is noted in the first few years of life as dry, blond, shiny hair that stands straight out from the scalp and cannot be combed.
• Electron microscopy shows longitudinal grooves that
make the hair abnormally rigid.
• AD, AR and sporadic cases reported

Answer 19

Uncombable Hair Syndrome

Question 20

what is this?

• AD
• Dry, fragile, sparse scalp hair that appears beaded on trichoscopy
• Mutation in type II hair keratins: KRT81, KRT83,
KRT86 as well as DSG4

Answer 20

Monilethrix (beaded hairs)