Alopecia

Question 1

Causes of localised Alopecia

Answer 1

A. Normal Scalp

1. Alopecia Areata
2. Trichotillomania
3. Head rolling
4. Autoimmune Diseases - SLE, Addisons’s
5. Stress
6. Endocrine - Hyperthyroidism, Hypopituitarism, DM
7. Heavy metal poisoning
8. Heparin
9. Incontinentia Pigmenti

B. Abnormal Scalp

1. Scar in scalp
2. Atopic eczema, psoriasis, Lichen Planus
3. Tinea capitis (fungal infection)

Question 2

Causes of Total Alopecia

Answer 2

1. Alopecia Totalis
2. Drugs: Cytotoxic drugs; Carbimazole, Carbamazepine, Valproate, Chloroquine, gold and Indomethacin
3. Malnutrition
4. Chronic illness
5. Irradiation
6. Ectodermal Dysplasia
7. Dystrophic Myotonia
8. Metabolic Disease - e.g. Homocystinuria

Ddx - Male baldness (Androgen effet with receding hairline)

Question 3

Alopecia Areata

Answer 3

• Pt poor prognosis
• Atopic eczema
• Rx -
  1. Systemic Steroids/ Intradermal steroid
  2. Minoxidil - topical
  3. PUVA= Psoralen UV light Rx

Question 4

Prognosis of Alopecia

Answer 4

1. Alopecia Totalis
2. Injured or eczematous - poor
3. Male baldness pattern -i.e. at hairline

Question 5

Steps in clinical examination

Answer 5

1. Look at Pattern, state of scalp, rest of hair and any broken hair piece on the pillow
2. If Patchy:
   Look at eyelashes and brow- Absent
   Skin ? Eczema ? Vitiligo
   Nails ? Dystrophic

3. If Total:
Look at Eye brow /lashes
Teeth and nails -?abnormal
Skin- Dermatitis/ Vitiligo/ Rashes around mouth and anus
Neck- Goitre
Hand - Inflammed joint, Myotonia