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ALOPECIA & VITILIGOALOPECIA & VITILIGO

GHADA BINSAIF, MD

ASSISTANT PROFESSOR & CONSULTANT

DERMATOLOGIST

KSU & KKUH

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ALOPECIAALOPECIA

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Hair TypesHair Types

VellousVellous

TerminalTerminal Androgen dependant terminalAndrogen dependant terminal

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Hair CycleHair Cycle

Hair growth is very dynamic

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How many hairs in the body?5 millions hairs; 100,000 in the scalp

Growth rate?0.3mm/day for scalp hair

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AlopeciaAlopecia

Scaring

(Irreversible)

NoneScaring

(Reversible)

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Alopecia AreataAlopecia Areata

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Sudden hair loss ( localized orgeneralized)Alopecia Areata affects up to 2%75% : Self recovery, 2-6 m

Causes :30%: +ve Family historyautoimmune

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Clinical findingsClinical findings Well demarcatedWell demarcated

Exclamation pointExclamation point

Normal scalpNormal scalp

Nail: pitting, ridgesNail: pitting, ridges

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Types of alopecia areataTypes of alopecia areata

-- Localized partialLocalized partial

-- Localized extensiveLocalized extensive

-- Alopecia ophiasisAlopecia ophiasis

-- Alopecia totalisAlopecia totalis

-- Alopecia universalisAlopecia universalis

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Bad prognostic factorsBad prognostic factors Young ageYoung age

AtopyAtopy

Alopecia totalis, universalis,Alopecia totalis, universalis,ophiasisophiasis

Nail changesNail changes

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DiagnosisDiagnosis ClinicallyClinically

H/E: sworm beesH/E: sworm bees

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Treatment

11.. ObservationObservation

22.Intralesional

Corticosteroids.

Intralesional

Corticosteroids

33.. Skin Sensitizers

Anthraline

Diphencyclopropenone (DPCP)others

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Others

Topical steroids

Systemic

Steroids

Cytotoxic Rx

Phototherapy

Minoxidil

Hair Transplant ( NO)

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Androgenetic Alopecia

(Male and Female Pattern Hair Loss)

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Androgen dependent loss of scalp hairAndrogen dependent loss of scalp hair

Androgenetic Alopecia affects up toAndrogenetic Alopecia affects up to 5050%%

of males andof males and 4040% of females% of females Autosomal dominant with variableAutosomal dominant with variable

penetrancepenetrance

8585% : +ve family history% : +ve family history

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5 ALPHA Reductase

Testosterone

DihydorTestosterone(Active)

Miniaturization ofTerminal Hairs

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Male Pattern Hair Loss

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Female Pattern Hair Loss

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TreatmentTreatment TopicalTopical: Neoxidil: Neoxidil 22%%-- 55% solution% solution

SystemicSystemic::

FenastrideFenastride

SpironolactoneSpironolactone

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Anagen effluviumAnagen effluvium

Telogen effluviumTelogen effluvium

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Telogen effluviumTelogen effluvium

Chronic alopeciaChronic alopecia

Reversible (but may be become chronic)Reversible (but may be become chronic)33--44 monthsmonths

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CausesCauses

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DrugsDrugs associatedassociated with telogen Effluviumwith telogen Effluvium

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Anagen effluviumAnagen effluvium Always related to cytotoxicAlways related to cytotoxic

chemotherapychemotherapy

Acute and severe alopeciaAcute and severe alopecia

Mostly reversible but not alwaysMostly reversible but not always

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Scaring AlopeciaScaring Alopecia SLESLEDLEDLE

LPLP

SarcoidosisSarcoidosis

LeprosyLeprosy

KerionKerion -- FavusFavus TraumaTrauma

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VitiligoVitiligo

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--Acquired cut. depigmentationAcquired cut. depigmentation--Kobner phenomenaKobner phenomena

CausesCauses-- GeneticGenetic-- Autoimmune dis.Autoimmune dis.-- NeuralNeural

Natural coarse?Natural coarse?

VariedVaried

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Why? Loss of normal melanocytesDopa stain

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Special studiesSpecial studies

TT44, TSH, FBS, TSH, FBS

ANA/Ro/La (prior to PUVA)ANA/Ro/La (prior to PUVA)

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TREATMENTTREATMENT

Sunscreen (sunburn, koebnerization, tanning)Sunscreen (sunburn, koebnerization, tanning)

Limited:Limited:ClassClass 33 topical GCtopical GC

Topical TacrolimusTopical Tacrolimus

Topical PUVATopical PUVA

Excimer laserExcimer laser

Resistant, Stable ofResistant, Stable of 22 years : Surgicalyears : Surgical

GeneralizedGeneralizedPhototherapyPhototherapy

Universal:Universal:

Bleaching agentBleaching agent